Affordable Care Act

Pre-Existing Conditions Under Obamacare

Updated on November 15, 2019

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A pre-existing condition is a health problem that existed or was treated before the effective date of your health insurance coverage. Most health insurance contracts have a pre-existing condition clause that describes how and when the health insurance company will cover medical expenses related to a pre-existing condition.

The Affordable Care Act (ACA or “Obamacare”) prohibited pre-existing condition exclusions for all plans beginning January 2014, which was great news for all insurance beneficiaries with pre-existing conditions. In addition, Obamacare prohibits pre-existing condition exclusions for all children under the age of 19 in new policies sold on or after September 23, 2010. 

Pre-existing conditions and insurance coverage

In some cases, a health insurance company may exclude a patient’s pre-existing condition from coverage under a new health insurance plan. This is more typical with individual and family health insurance plans and less common with group health insurance plans.

The Health Insurance Portability and Accountability Act (HIPAA), which was passed in 1996, imposed certain conditions on when a health insurance company could exclude coverage for a pre-existing condition. As stated earlier, the ACA went one step further by prohibiting pre-existing condition exclusions for all plans since January 2014.

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