ObamaCare Pre-existing Conditions

No More Pre-existing Conditions Since 2014

ObamaCare eliminated pre-existing conditions starting in 2014. No more pre-existing conditions means you can’t be denied coverage, charged more, or denied treatment based on health status.

Considering 1 in 2 Americans has a health condition that qualifies as a pre-existing condition, the Affordable Care Act (ObamaCare) doing away with pre-existing conditions and making all coverage Guaranteed Issue is a big deal.

According to the CDC data from 2009 [pdf]:

  • 75 percent of all health care expenditures go toward treating chronic diseases, many of which are preventable.
  • Chronic diseases cause 7 in 10 deaths each year in the United States.
  • About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness.

You can do a quick check of the current figures from the CDC and see that statistics like this are relatively constant.

UPDATE FOR 2018 – 2021: For now insurers are still banned from denying you coverage or charging you more for having a preexisting condition, however a 2018 court case that has made its way to the Supreme Court has declared the ACA illegal. If the court rules against the ACA then pre-existing conditions discrimination could become legal again. A final decision on the ruling is expected by June 2021.

ObamaCare means no more pre-existing conditions: Being sick or having been sick in the past can no longer keep you from coverage.

Only Minimum Essential Coverage Protects People with Preexisting Conditions

You can get covered in any major medical plan during open enrollment regardless of your health status. However, outside open enrollment, some health insurance types can still discriminate based on health status.

To get the preexisting conditions protections, make sure you understand if you are getting a Major Medical Plan that counts as Minimum Essential CoverageShort Term Health Insurance can still deny you or charge more for preexisting conditions.

Preexisting Conditions Don’t Affect Cost or Cost Assistance

Being sick or having a preexisting condition won’t affect the cost of your insurance or the availability of cost assistance.  If you plan to use a lot of medical expenses and prescription drugs, make sure to compare networks and drug formularies and shop for a plan with low out-of-pocket costs like coinsurance, deductible, and copays.  Get covered now.

What Does ObamaCare Do For Sick People?

If you are currently sick or have been sick in the past the Affordable Care Act, ObamaCare, offers you significant protection. Let’s take a quick look at some of the key provisions that ensure that people with preexisting conditions get the help they need:

• Insurance companies can’t deny coverage or charge more for people with preexisting conditions.

• Insurance companies can no longer deny you for any reason other than fraud.

• Insurance companies can’t put lifetime or annual dollar limits on Essential Health Benefits which include screenings, preventions, and treatments for most life-threatening sickness such as cancer.

• All plans cover free wellness and preventive services. There is no longer a reason to put off doctor visits meaning early detection will help stop sickness before it starts and early treatments will help treat people before its too late.

• Subsidies are available for those who make less than 400% of the Federal Poverty Level. This helps to make both premium costs and out-of-pocket costs more affordable.

Note: The benefits, rights, and protections offered to those with preexisting conditions only apply to plans that have to comply with the ACA. If your plan was issued before 2014 and would have faced cancellation in 2014, but the “fix” allowed you to keep your plan, you may be exempt from any or all of the above.

How Does ObamaCare Help People With Cancer?

If you or a loved one has cancer or is at risk then the Affordable Care Act offers some pretty groundbreaking new benefits, rights, and protections.  It doesn’t matter if you are sick now or have needed treatment in the past you cannot be denied coverage or cost assistance, and you won’t pay more for coverage. Check out this PDF on ObamaCare and Cancer.

Preventing Chronic Disease

While certainly not every preexisting condition is preventable, many are. Chronic diseases are the most common and costly of all health problems, but they are also the most preventable. Four common, health-damaging, but modifiable behaviors—tobacco use, insufficient physical activity, poor eating habits, and excessive alcohol use—are responsible for much of the illness, disability, and premature death related to chronic diseases. By ensuring that all Americans are covered and have access to preventive care and treatments, and by focusing on health and wellness, we can improve the health of our nation while driving our health care costs down.

ObamaCare pre-existing conditions

Pre-existing Conditions and the Mandate to Buy Insurance

The reason people were denied coverage and treatments or charged more in the past was very simple, treating sick people is expensive.

The higher the risk a customer is, the less profitable it is for the insurance company to cover them. Taking this into account, insurance companies and legislators came to a compromise. Health insurance companies would agree to cover everyone and give them all the same essential health benefits, but in return, everyone who was able to afford insurance would have to buy insurance.

Everyone must obtain insurance each year or pay a fee. Learn more about the ObamaCare Individual Mandate.

Think about it. If no one could be denied coverage for being sick and didn’t HAVE to buy insurance, everyone would just wait until they were sick to buy insurance. If that happened then insurance companies couldn’t afford to stay in business then no one would be able to afford healthcare.

The following video explains how ObamaCare affects costs for Americans with pre-existing conditions:

Addressing Insurance Costs Not Health Care Costs

About 60% of bankruptcies in the U.S. are medical-related, and many of these individuals had health insurance at the time of bankruptcy. Although ObamaCare does a lot to regulate the health insurance industry to ensure that more Americans have access to affordable quality health insurance, it doesn’t fully address the underlying issue of the high costs of healthcare in the first place. Luckily knowing you must be covered and can’t be dropped addresses the human side of the issue, our right to healthcare.

Beyond Covering Pre-existing Conditions

The trade of the mandate to buy insurance for the mandate to cover everyone is one of the foundations of the entire Affordable Care Act. Along with the right to treatment and coverage Americans also get some new benefits, rights, and protections that are discussed in detail on our site. They include but are not insurance companies not being able to drop you when you are sick or if you make an honest mistake on your application, insurers not being able to charge women more than men and a number of new free preventative and wellness services that are included with all health plans starting after 2014.

Medicaid, CHIP, Medicare, and other insurers are included in the mandate to cover preexisting conditions.

One exception: Grandfathered individual health insurance plans

The only exception is for grandfathered individual health insurance plans–the kind you buy yourself, not through an employer. They do not have to cover pre-existing conditions.

If you have one of these plans, you can switch to a Marketplace plan during open enrollment and immediately get coverage for your pre-existing conditions.

What is a Grandfathered Plan: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also advise consumers how to contact the U.S. Department of Labor or the U.S. Department of Health and Human Services with questions.

Preexisting Condition Limitations Under ObamaCare

Grandfathered plans and short-term health insurance can still place limitations on preexisting conditions. This means they can either not cover costs related to preexisting conditions or deny coverage altogether for preexisting conditions.


Since customers with pre-existing conditions weren’t able to enjoy their new rights to coverage until 2014, ObamaCare created something called PCIP in the meantime. PCIP runs through 2017, but new enrollments are closed. Go here to learn more about the 17 sates that offer temporary coverage to high-risk consumers https://www.pcip.gov/. Even though PCIP enrollment is closed, you may still have options.

If you have been denied health coverage, you can use the marketplace to buy insurance for 2014. The following video will explain what people could have done in the meantime:

Ensuring More People Buy Insurance

To ensure that more people could buy insurance ObamaCare created state-specific marketplaces where Americans making under 400% of the Federal poverty level can purchase subsidized regulated insurance that meets the new standards of Obamacare. These are called health insurance marketplaces.

Getting Health Insurance the Covers Pre-existing Conditions

Getting health insurance that will cover your pre-existing conditions is as easy as filling out an application for your State’s health insurance marketplace during open enrollment Open enrollment. Find out more about your State’s Health Insurance Marketplace here.

If you would like to shop for health insurance that isn’t sold through the marketplace, then make sure the plan you buy covers essential health benefits, pre-existing conditions, and meets the requirements for minimum essential coverage to ensure you get the same quality health insurance as the rest of us.


ObamaCare Means no More Pre-existing Conditions

Author: Thomas DeMichele

Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...

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