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A pre-existing condition is one that existed before a person’s health benefits went into effect. Examples of these include chronic diseases such as diabetes, cancer, and other issues that were affecting the policyholder’s health prior to the date the benefits started. Some insurers would not cover these conditions or accept applicants with them, leading to many people having sub par health care coverage or even no coverage at all. With the ACA, insurers cannot turn down someone with a pre-existing condition. Insurers cannot charge you more or deny you coverage, nor can they raise your rates based on your health once you are enrolled in their plan. Medicaid and CHIP also cannot refuse to accept people or upcharge people based on their pre-existing conditions.
Pregnancy is covered, even if you’re pregnant when you apply. An insurance plan cannot reject or upcharge someone because they are pregnant at the time of application. Once enrolled, the pregnancy is covered, so services like prenatal care must be covered under the policy. If you give birth or adopt after you enroll then you qualify for a Special Enrollment Period, which means that your coverage can start from the date you give birth or adopt, even if you’re officially enrolled up to sixty days later.
Exceptions: Grandfathered Plans
Grandfathered plans are those that were in place prior to March 23, 2010. These plans are permitted to offer the same level of coverage they did prior to the ACA, even if that coverage is against the current law. If you are on a grandfathered plan that does not cover pre-existing conditions and you require coverage, there are some options. You can switch to a marketplace plan during open enrollment or you can buy a marketplace plan outside of the open enrollment period when your grandfathered plan ends. Then, after the end of your plan, you can qualify for a Special Enrollment Period to help you get coverage.