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Health Insurance Market Reforms: Pre-Existing Condition Exclusions

Insurers pursue multiple strategies to reduce the cost of covering enrollees with pre-existing conditions, or medical conditions and health problems that existed before the individual enrolled in a health plan. One strategy, the pre-existing condition exclusion, allows insurers to refuse to cover any costs associated with care for a pre-existing condition permanently or over a period of time.

Beginning January 1, 2014, insurers in the individual and group markets will be prohibited from imposing pre-existing condition exclusions under the Affordable Care Act. This new fact sheet provides an overview of how pre-existing condition exclusions are regulated under current law, and how the ACA will change those regulations in 2014, enabling consumers to access necessary benefits and services beginning from their first day of coverage.

Fact Sheet (.pdf)