Health benefits & coverage

Coverage for pre-existing conditions

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 2022 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.

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.