All Marketplace plans cover the essential health benefits for pre-existing conditions. This means that regardless if any medical condition existed prior to or after your coverage started, no insurers will be able to reject you, refuse to pay for your essential health benefits, or even charge you a higher price for medical care. They are also restricted from charging more for men or women.
With the exception of grandfathered plans, insurance companies are not allowed to refuse coverage or increase their charges due to pre-existing medical conditions. And once you are covered, they can’t refuse to cover the treatment for it. This also applies to Medicaid and CHIP coverage.
Pregnancy and Adoption:
Pregnancy also falls into the pre-existing category. You can enroll in a Marketplace plan after your pregnancy during open enrollment or with Special Enrollment Period. And your coverage will be effective as soon as your new plan begins.
As with pregnancy, adoption will also qualify you for a Special Enrollment Period. You can enroll or change plans outside of the Open Enrollment period and your new plan will take effect from the start of the adoption or date of birth when you apply for coverage not past 60 days of that date.
Need 2016 HealthCare Coverage? There is still time to qualify!
Pre-existing Conditions and Grandfathered Plans:
As mentioned earlier, grandfathered plans purchased on your own (not through your employer) are exempt from this requirement. These grandfathered individual insurance plans are under no legal obligation to cover pre-existing conditions.
You do have the option to cancel your grandfathered plan and purchase Marketplace coverage that will cover pre-existing conditions. If your grandfathered plan year ends, you can opt to purchase a Marketplace plan. A plan ending will qualify you for a special enrollment period