Health benefits & coverage

Coverage for pre-existing 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 give birth or adopt after enrolling in your Marketplace plan for the year:
    • Your child’s birth or adoption qualifies you for a
      Special Enrollment Period

      A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.

      Refer to glossary for more details.

      . This means you can enroll in or change plans outside the annual Open Enrollment Period.
    • Your coverage can start from the date of birth or adoption, even if you enroll up to 60 days afterward.

Exception: grandfathered plans don’t have to cover pre-existing conditions

• 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.