Seven Ways the ACA Pro­tects Peo­ple with Pre­ex­ist­ing Conditions

Obamacare’s next open-​enrollment period begins on Novem­ber 1, 2019. As we approach this date, many eyes are watch­ing a fed­eral court case, Texas v. United States, that seeks to inval­i­date the entire Afford­able Care Act. The next deci­sion in the case may come down this fall, cre­at­ing more con­fu­sion about the future of the law.

If the courts even­tu­ally over­turn the ACA, almost 20 mil­lion Amer­i­cans stand to lose their health insur­ance. With­out a new law in place, many would lose cov­er­age because of pre­ex­ist­ing health con­di­tions. (Pre­ex­ist­ing con­di­tions include ill­nesses like can­cer, asthma, epilepsy, and dia­betes. The list also includes men­tal ill­nesses such as depres­sion or anx­i­ety, and may extend to ordi­nary life expe­ri­ences like acne or preg­nancy.) Those with pre­ex­ist­ing con­di­tions who don’t lose their cov­er­age out­right could con­tend with sky-​high pre­mi­ums and unman­age­able out-​of-​pocket costs.

ACA Pro­tec­tions for Peo­ple with Pre­ex­ist­ing Conditions

Here are seven impor­tant ways the Afford­able Care Act pro­tects peo­ple with pre­ex­ist­ing conditions:

1. Insur­ers can’t deny you health cov­er­age. The ACA’s “guar­an­teed issue” pro­vi­sion means that insur­ers must offer health plans to every appli­cant, with­out con­sid­er­ing their health sta­tus or other factors.
2. Insur­ers can’t use your health sta­tus to raise your pre­mi­ums. The ACA’s “com­mu­nity rat­ing” rule pre­vents insur­ance com­pa­nies from set­ting pre­mi­ums within a geo­graphic area based on age, gen­der, race, health sta­tus, or other factors.
3. Insur­ers can’t deny you the ser­vices you need to treat pre­ex­ist­ing con­di­tions. The Afford­able Care Act says that health insur­ers can’t limit or deny ser­vices based on the fact that you have a health con­di­tion that was present before your cov­er­age started.
4. Addi­tional pro­tec­tions for peo­ple who get insur­ance through their job. Many safe­guards for folks with job-​based insur­ance existed before the ACA, but the ACA expanded these pro­tec­tions. First, large employ­ers must pro­vide a min­i­mum pack­age of health ben­e­fits, and they may not place lim­its on the amount of ben­e­fits you receive. In addi­tion, you can get indi­vid­ual cov­er­age if you leave your job, even if you have a pre­ex­ist­ing condition.
5. Insur­ers must offer you a full ben­e­fits pack­age. Under the ACA, insur­ance plans must cover ten essen­tial health ben­e­fits. (But see how the Trump Admin­is­tra­tion has eroded this part of the law by cre­at­ing a loop­hole for skimpy, short-​term plans.)
6. Insur­ers can’t ask you to pay more than a cer­tain amount for care each year. The ACA puts a cap on the amount you have to pay out of pocket each year.
7. Insur­ance plans must include free pre­ven­tive ser­vices. For a list of these ser­vices, see Under­stand­ing Obamacare’s Pre­ven­tive Health Care Ben­e­fits.

More Infor­ma­tion

To learn more about the ben­e­fits of health insur­ance plans offered under the ACA, see What Do Oba­macare Health Plans Cover?

For infor­ma­tion about find­ing afford­able health insur­ance in your state, visit Legal Consumer’s Oba­macare learn­ing cen­ter.