Coverage for Pre-Existing Conditions
Good news! All Marketplace plans must cover treatment for pre-existing medical conditions. 
  • No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. 
  • Once you’re enrolled, the plan can’t deny you coverage or raise your rates based only on your health. 
  • Medicaid and the Children’s Health Insurance Program (CHIP) also can’t refuse to cover you or charge you more because of your pre-existing condition. 
Pregnancy is Covered From The Day Your Plan Starts
  • If you’re pregnant when you apply, an insurance plan can’t reject you or charge you more because of your pregnancy
  • Once you’re enrolled, your pregnancy and childbirth are covered from the day your plan starts. 
  • If you have a 2021 health plan & give birth or adopt after you enrolled: 
  • Your child’s birth or adoption qualifies you for a Special Enrollment Period. This means you can enroll in or change plans outside the annual Open Enrollment Period.
Exception: Grandfathered plans don’t have to cover pre-existing conditions

Grandfathered plans don’t have to cover pre-existing conditions or preventative care. If you have a grandfathered plan and want pre-existing conditions covered, you have 2 options:

  • You can switch to a Marketplace plan that will cover them during Open Enrollment
  • You can buy a Marketplace plan outside Open Enrollment when your Grandfathered plan year ends, and you’ll qualify for a Special Enrollment Period.

However, right now, there is an active Special Enrollment Period as a result of a signed executive order, so anyone needing to sign up for insurance can sign up right now, instead of waiting for the Annual Open Enrollment Period in November. This Special Enrollment runs from February 15th, 2021 to May 15th, 2021.