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.
- Your coverage can start from the date of birth or adoption, even if you enroll up to 60 days afterward.
Learn more about coverage for pregnancy and childbirth.
Exception: grandfathered plans don’t have to cover pre-existing conditions
Grandfathered plans don’t have to cover pre-existing conditions or preventive 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.
Learn more about grandfathered plans and what to do when your plan is changed or cancelled.