Preexisting Condition Exclusions

Related Topics

Related Topics

Affordable Care Act

In the past, many health insurance policies excluded health conditions that had been diagnosed prior to applying for coverage. Guaranteed issue—requiring insurers to take all applicants, including people with preexisting conditions—will eventually apply to everyone. Since September 2010, preexisting condition exclusions have been prohibited for children. For adults, the ban takes effect in 2014. Until then, individuals who have a preexisting condition and have been uninsured for 6 months may obtain coverage through either the new national risk pool or one in their state.

Since being implemented, restrictions have eased and premiums have been lowered in the states where the plan is federally administered. For more information, visit or see this state-by-state list of lower premiums available through the federal PCIP program since July 1, 2011.

The Patient Protection and Affordable Care Act will bring important changes to the individual market in 2014, including eliminating the ability of insurers to deny coverage based on preexisting conditions.

For further information on preexisting conditions, see the tool box for “Preexisting Conditions.”