ObamaCare & Pre-existing Conditions

A pre-existing condition is a medical condition that is excluded from coverage by an insurance company. It means a medical condition that started before a person's health insurance goes into effect.  Because the condition was believed to exist prior to the individual obtaining a policy from the particular insurance company. Unless ObamaCare comes into force, that is, before 2014 some insurance policies would not cover expenses due to pre-existing conditions.

Affordable Care Act  popularly known as ObamaCare eliminates pre-existing conditions starting 2014. Under the Affordable Care Act, health insurance companies can’t refuse to cover a subscriber or charge him more just because he has a “pre-existing condition”, that is, a health problem he had before the date that new health coverage starts. They also can’t charge women more than men. These rules went into effect for plan years beginning on or after January 1, 2014.

No more pre-existing conditions means that health insurance companies can no longer charge more or deny coverage to subscribers or their children because of a pre-existing health condition like asthma, diabetes, or cancer. Health insurance companies cannot limit benefits for that condition either. Once a person has insurance, they can't refuse to cover treatment for his pre-existing condition.

Being sick or having been sick in the past can no longer can keep health insurance participant from coverage. Considering 1 in 2 Americans has a health condition that qualifies as a pre-existing condition, doing away with pre-existing conditions is a big deal for those people.

One Exception: Grandfathered Plans

The pre-existing coverage rule does not apply to “grandfathered” individual health insurance policies. A grandfathered individual health insurance policy is a policy that customers bought for  or thekselves of for their family on or before March 23, 2010 that has not been changed in certain specific ways that reduce benefits or increase costs to consumers.

Pre-Existing Condition Insurance Plan (PCIP) Coverage

The Pre-existing Condition Insurance Plan (PCIP) ended on April 30, 2014.  The PCIP program provided health coverage options to individuals who were uninsured for at least six months, had a pre-existing condition, and had been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. Now, thanks to the Affordable Care Act, health insurance plans can no longer deny anyone coverage for their pre-existing condition, and so PCIP enrollees can transition to a new plan outside of the PCIP program.