A pre-existing condition is any health issue you had before new coverage started, whether it's diabetes, asthma, a previous surgery, or even pregnancy.
Before the Affordable Care Act, insurance companies could deny you coverage or charge you more because of a pre-existing condition. That changed in 2014. Under the ACA, health plans sold on the Marketplace and most employer plans cannot refuse to cover you, charge you higher premiums, or exclude coverage for any health condition you already have.
This protection applies regardless of how serious or minor the condition is. Whether you're managing high blood pressure, depression, cancer, or a past knee replacement, your plan must cover treatment for it the same way it covers any other condition.
The only exception: grandfathered health plans (plans that existed before March 23, 2010, and haven't made major changes) may still have some pre-existing condition limitations. Short-term health insurance plans are also exempt from this rule, which is one reason they're cheaper but riskier.
If you're shopping for ACA coverage through the Marketplace, you never need to worry about being turned away for your health history.
No. Under the ACA, insurance companies cannot charge you higher premiums based on your health status. The only factors that can affect your premium are age, location, tobacco use, and plan category.
No. Marketplace applications do not ask about your medical history. Your health conditions have no bearing on eligibility, plan options, or pricing for ACA plans.
Not on ACA plans. A gap in coverage does not restore pre-existing condition exclusions for Marketplace or employer group plans. However, if you're enrolling in a grandfathered plan or short-term plan, a coverage gap could matter.
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