Quick answer
You can’t be turned down for most health insurance because of a pre-existing condition. Since 2014, the Affordable Care Act has barred marketplace plans, other individual ACA plans and job-based plans from refusing you, charging you more or excluding care because of your health history. The main exceptions are coverage that isn’t ACA insurance, like short-term plans, and Medicare Supplement plans bought outside your guaranteed enrollment windows.
Key takeaways
- ACA plans must accept you and cover your condition from day one, with no waiting period.
- Your health can’t affect your premium. Only age, location, tobacco use and who’s on the plan can.
- Short-term plans, fixed indemnity plans and health care sharing ministries can still reject you or exclude your condition.
- You can buy an ACA plan during open enrollment or within 60 days of a qualifying life event.
- Medicare Supplement insurers can use your health to deny or price coverage outside your guaranteed-issue periods, so time that purchase carefully.
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What the ACA protects
Before 2014, insurers selling individual policies could turn down applicants with conditions like diabetes, cancer or even a past pregnancy, charge them much more, or refuse to pay for care related to the condition. States ran high-risk pools as a last resort. The ACA ended that for ACA-compliant coverage:
- Guaranteed issue. Insurers must sell you a plan during open enrollment or a special enrollment period.
- No pre-existing condition exclusions. Care for your condition is covered like any other care, starting on day one.
- No health-based pricing. Premiums can vary only by age, location, tobacco use and the number of people covered.
- Essential benefits. Plans cover prescriptions, hospital care, mental health care and more, so a condition can’t be worked around by leaving out the care it needs.
These rules apply to marketplace plans, ACA plans bought directly from an insurer and job-based plans. Most of the old high-risk pools closed because they’re no longer needed.
Where pre-existing conditions still matter
- Short-term health plans can ask about your health, decline you, and refuse to pay for pre-existing conditions. See short-term health insurance.
- Fixed indemnity and other limited-benefit plans pay set amounts and may exclude conditions.
- Health care sharing ministries aren’t insurance and often limit sharing for pre-existing conditions.
- Medicare Supplement (Medigap). You have a six-month window after you turn 65 and enroll in Part B when insurers must sell you any plan at the standard price. After that, in most states, they can use your health to deny you or charge more.
- Grandfathered plans. A few old individual policies from before 2010 that people have kept can still have exclusions. They’re closed to new members.
How to get covered with a pre-existing condition
- Enroll during open enrollment. For 2027 coverage, it runs November 1, 2026, to January 15, 2027, on HealthCare.gov.
- Use a special enrollment period if you’ve had a qualifying event, such as losing other coverage.
- Check Medicaid and CHIP, which accept applications all year and don’t consider your health.
- Look at job-based coverage through your employer or a spouse’s.
- Compare plans for your condition. Check that your specialists are in network, your medications are on the drug list, and the out-of-pocket maximum is one you can handle.
Not every insurer offers the same networks or drug lists, so compare a few; our overview of the best health insurance companies is a place to start. For specific conditions, see health insurance if you have diabetes and can cancer patients get health insurance.
Choosing a plan when you need regular care
If you see doctors often or take expensive medications, a gold or platinum plan with a lower deductible may cost less over the year than a cheap bronze plan. If your income is under 250% of the poverty level, a silver plan with cost-sharing reductions can be even better. See the difference between bronze, silver, gold and platinum plans and what an out-of-pocket maximum is.
Ready to compare plans that have to cover your condition? See quotes by ZIP code.
Frequently asked questions
Is there a waiting period for pre-existing conditions?
No, not on ACA plans. Coverage for your condition starts when your plan starts.
Can my job-based plan exclude my condition?
No. Job-based plans can’t exclude pre-existing conditions or charge you more than coworkers because of your health.
Does a pre-existing condition affect Medicare?
Not Original Medicare or Medicare Advantage. It can affect Medigap outside your guaranteed-issue windows.
What counts as a pre-existing condition?
Any health problem you had before your coverage starts, such as asthma, diabetes, cancer, heart disease, depression or pregnancy.
Sources
This article is general information, not legal or insurance advice. Rules for non-ACA coverage vary by state, so check HealthCare.gov, your state insurance department or a licensed agent for your situation. Last reviewed September 2026.