Skip To Main Content

Main Content

Coverage for individuals with pre-existing medical conditions

Please Log in or select your state for the most up to date information

pre existing condition limits

Since 2010, health plans cannot limit or deny benefits for those younger than 19 with a pre-existing condition. To learn more, see No pre-existing condition limits for birth to age 19.

As of 2014, this part of the health care reform law also applies to people 19 and older. This means health insurers cannot refuse to cover you or renew your plan because you have (or had) cancer, asthma, high blood pressure, arthritis or another health problem. If you have a condition, you can still get health coverage.

A pre-existing condition is a health problem found or treated before you signed up for coverage. This applies whether you were covered under a different plan or had no coverage at all.

What's different?

In the past, health insurers could limit or deny benefits or coverage because of a pre-existing condition.

What's different now?

Health insurers cannot deny, limit or leave out coverage of certain conditions because of a health problem you had before applying for a plan.

How it impacts you

When does this provision start?

It has already started.This applies for those younger than 19 and, as of 2014, for those 19 and older.

What can I do if my plan tries to deny coverage because of a pre-existing condition?

Under the Affordable Care Act, you have the right to appeal. To learn more, see Rights and protections.

I'm 20 years old. Does this law apply to me?

Yes. This protection has been extended to Americans of all ages as of 2014.

What if I have a pre-existing condition and need coverage right now?

The Pre-Existing Condition Insurance Plan (PCIP) offers coverage if you've been:

  • Denied coverage because of a pre-existing condition.
  • Uninsured for six months or more.

The PCIP plan covers a wide range of benefits, such as hospital care, prescription drugs and primary care. It doesn't charge more in premium because of your medical condition. Depending on where you live, you can sign up for a state or federal program.

To learn more about this plan, see Pre-Existing Condition Insurance Plan on the site.

Member Log In

Useful Tools

  • Go
  • *Required Field:
    Can't remember your claim number? View Claims