Yes. Under the Affordable Care Act, ACA-compliant health plans, including Marketplace and most employer plans, cannot deny you coverage or charge you more because of a pre-existing condition. The exceptions are products outside the ACA rules, like short-term health plans, and types of insurance such as life, disability and long-term care, where insurers can still consider your health.
If you live with diabetes, asthma, cancer history, depression or any other ongoing condition, the fear of being turned away by an insurer is real. Before 2014, many people were denied individual health coverage or charged far more because of their medical history.
That changed with the Affordable Care Act. But the protections apply to some types of insurance and not others, so it’s worth knowing exactly where you stand.
Getting Insurance With a Pre-Existing Condition: What Counts?
A pre-existing condition is a health issue you had before your new coverage starts. Common examples include:
- Diabetes, heart disease and high blood pressure
- Asthma and COPD
- Cancer, current or in remission
- Depression, anxiety and other mental health conditions
- Pregnancy
- Past surgeries or chronic back problems
There’s no single official list, which is exactly why the ACA protections matter: for covered plans, it doesn’t matter what your condition is.
Your Health Insurance Rights Under the ACA
ACA-compliant health plans, including plans sold on HealthCare.gov and state exchanges, individual plans bought directly from insurers that follow ACA rules, and most employer plans, must follow these rules:
- No denial: they can’t refuse to sell you coverage because of your health.
- No higher premium for health: premiums can vary by age, location, tobacco use and family size, but not by health status or medical history.
- No exclusion of your condition: they can’t refuse to cover treatment for a pre-existing condition.
- Coverage starts right away: there’s no pre-existing condition waiting period on these plans once your coverage begins.
These plans also cover essential health benefits, such as prescription drugs, hospitalization, mental health care and maternity care, and they have an annual out-of-pocket maximum, which matters a lot if you need frequent care.
When can you enroll?
Timing is the one real catch. Marketplace Open Enrollment generally runs November 1 to January 15 in most states (some state exchanges differ). Outside that window, you’ll typically need a qualifying life event, like losing other coverage, moving, getting married or having a baby, which usually gives you 60 days to sign up. Medicaid and CHIP accept applications year-round if you qualify.
Where Your Health Can Still Matter
Not every product follows ACA rules. Here’s how common options compare:
| Type of coverage | Can your health affect approval or price? |
|---|---|
| Marketplace and ACA individual health plans | No |
| Employer group health plans | No denial or exclusion for pre-existing conditions |
| Medicaid and CHIP | No, eligibility depends on income and other factors |
| Short-term health plans | Yes, they can ask about health, deny coverage, or exclude conditions |
| Life insurance | Yes, most policies use medical underwriting |
| Disability and long-term care insurance | Yes, health is usually considered |
| Medicare Supplement (Medigap) | Protected during certain enrollment windows; outside them, insurers in many states can use medical underwriting |
Be especially careful with short-term health plans. They can look cheap, but they often exclude pre-existing conditions and don’t have to cover all essential health benefits. Read the fine print before relying on one.
Life Insurance With a Pre-Existing Condition
You can often still get life insurance, but your health may affect your price and which policy types are available. Options include:
- Fully underwritten term or permanent life: may still be possible if your condition is well managed. Price depends on the insurer’s assessment.
- Simplified issue life: asks health questions but usually no medical exam. Coverage amounts are often lower.
- Guaranteed issue life: no health questions, but typically lower coverage, higher cost per dollar of coverage, and a waiting period before the full death benefit applies.
- Group life through work: employer coverage often requires little or no health information up to a certain amount.
Insurers view conditions differently. One may rate well-controlled diabetes more favorably than another, which is why an independent agent who works with multiple companies can be helpful.
Tips for Getting Covered
- Don’t let coverage lapse. Losing coverage can trigger a Special Enrollment Period, but only if you act within the deadline.
- Check networks and formularies. Make sure your specialists and medications are covered before choosing a plan.
- Compare out-of-pocket maximums. With an ongoing condition, a plan with a higher premium and lower out-of-pocket costs may save you money.
- See if you qualify for help. Premium tax credits and cost-sharing reductions on Silver plans can lower costs depending on your income.
- Be honest on applications. For life and disability insurance, misrepresenting your health can lead to a denied claim later.
What If You Have Employer Coverage or Medicare?
If you get insurance through work, your pre-existing condition can’t be excluded and you can’t be charged more than coworkers in the same plan because of your health. When you leave a job, COBRA may let you keep the same plan, generally for up to 18 months at employers with 20 or more employees, and you usually have 60 days to elect it. Many states have mini-COBRA laws for smaller employers.
If you’re turning 65, Original Medicare and Medicare Advantage plans can’t turn you down for health reasons, with limited exceptions. For Medigap, your best protection usually comes during your Medigap Open Enrollment Period, the six months that start when you’re 65 or older and enrolled in Part B. During that window, insurers generally can’t deny you or charge more because of your health. Outside it, rules vary by state, so plan ahead.
Bottom Line
Yes, you can get health insurance with a pre-existing condition, and ACA-compliant plans can’t deny you or charge you more for it. The key is enrolling during Open Enrollment or a Special Enrollment Period and avoiding plans that don’t follow ACA rules. For life, disability and long-term care insurance, your health can still matter, so compare several insurers. Rules vary by state and plan, so check HealthCare.gov or your state exchange, ask your HR department, or speak with a licensed agent about your options.
Frequently asked questions
Can an employer plan exclude my pre-existing condition?
No. Under the ACA, employer group health plans can't deny you coverage or exclude care for a pre-existing condition.
Is pregnancy a pre-existing condition?
Pregnancy can be considered a pre-existing condition, but ACA-compliant plans can't deny you or charge more because you're pregnant, and maternity care is an essential health benefit.
Can I get life insurance if I have a serious illness?
Often yes, though your options and price may be affected. Simplified issue, guaranteed issue or group life coverage through work can be alternatives if traditional policies are hard to get.
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This article is for general information only and is not insurance, legal, tax or medical advice. Rules, coverage and prices vary by state, plan and insurer. Check your policy documents and speak with a licensed agent, your HR department or HealthCare.gov before making decisions.
