A pre-existing condition exclusion period was a waiting period during which a health plan refused to cover treatment for any medical condition you had before your coverage started. During this period, which could last up to 12 months (or 18 months for late enrollees), your plan would not pay for services related to your pre-existing condition even though you were paying premiums.
This practice is now banned for most health insurance. Under the ACA, Marketplace plans, new employer group plans, and individual health plans cannot impose pre-existing condition exclusion periods. The ban took effect for all plans starting on or after January 1, 2014.
However, there are limited exceptions. Grandfathered health plans (plans that existed before March 23, 2010, and haven't made significant changes) may still use pre-existing condition exclusion periods in some cases. Additionally, short-term health insurance plans are not required to follow ACA rules, so they can still exclude pre-existing conditions entirely.
If you're enrolling in an ACA-compliant plan through the Marketplace, you will not face any exclusion period. Your coverage for pre-existing conditions begins on your plan's effective date, just like every other covered benefit.
For anyone in a grandfathered plan who faces this restriction, creditable coverage (proof that you had prior health insurance) can reduce or eliminate the exclusion period.
For ACA-compliant plans, including all Marketplace and new employer plans, the answer is no. Grandfathered health plans and short-term health insurance may still apply exclusion periods in limited circumstances.
Creditable coverage is proof that you had prior health insurance. In the rare case where an exclusion period still applies (like a grandfathered plan), creditable coverage can reduce or eliminate the waiting period day-for-day.
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