Can a pre-existing condition keep someone from getting covered?

Short answer: No. ACA-compliant plans can’t deny coverage, charge more, or exclude benefits because of a pre-existing condition, in either the individual or small-group market.

Since 2014 the ACA has prohibited pre-existing-condition exclusions and health-based pricing in the individual and small-group markets. Insurers must offer coverage on a guaranteed-issue basis regardless of health history, can’t charge a sick person more than a healthy one, and can’t carve out coverage for a prior condition. (One exception to watch: medically underwritten level-funded/self-funded arrangements ask health questions at setup, which affects the group’s rate rather than an individual’s eligibility.)

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