Clear, practical information for your coverage decisions

ACA Coverage and Pre-Existing Conditions

A general overview of key ACA protections in Marketplace coverage.

ACA-compliant individual and group health plans generally cannot deny coverage or charge more because of a pre-existing health condition. Marketplace plans must cover essential health benefits, subject to plan terms and applicable rules. These protections are a core part of the ACA framework.

What this does not mean

It does not mean every service, treatment, provider, or medication is covered without limits or cost-sharing. Plans can have provider networks, deductibles, coinsurance, formularies, prior authorization rules, and other terms that apply to covered benefits.

Review the exact plan

Check the Summary of Benefits and Coverage, evidence of coverage, network, and drug formulary. For questions about a specific benefit, contact the insurer using the plan's official customer service information.

General information: HealthCare.gov: pre-existing conditions.

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