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Is there any chance I will be turned down for coverage by a health insurance exchange?

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Q. Is there any chance I will be turned down for coverage by a health insurance exchange?

A. The main idea behind the Affordable Care Act was to remove the barriers to insurance coverage for most Americans who remained uninsured because of pre-existing conditions or issues of cost.

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An executive order signed by President Biden has authorized a COVID-related special enrollment period on HealthCare.gov. The SEP will run from February 15 to August 15.

The law removed most of those barriers. So not only can a plan sold through your state’s health insurance exchange plan not turn you down because of a pre-existing condition, it also won’t exclude pre-existing conditions from your coverage or charge you higher premiums based on your medical history. These regulations apply to all individual major medical health insurance, regardless of whether they’re sold through the exchange or off-exchange.

The ACA includes a Patients’ Bill of Rights that helps consumers in a number of other ways, such as:

Limited enrollment windows (but the rules are different in 2021)

It’s important to understand, however, that health insurance is now typically only available for purchase during open enrollment, or if you experience a qualifying event. These limited enrollment windows apply both on and off the exchange. If you try to enroll outside of open enrollment, without a qualifying event, your enrollment will be rejected. So while the days of getting turned down because of medical history are long gone, it’s still possible to be turned down for health insurance, based on when you apply.

For 2021 only, however, the rules are different. To address the ongoing COVID pandemic, there’s a one-time enrollment window during which people can enroll even if they don’t have a qualifying event. In most states, this window continues through August 15, 2021, with coverage effective the first of the month following enrollment. This window is an opportunity for uninsured people to enroll, and in most states it also provides significant flexibility to allow people who already have marketplace coverage to switch to a different plan, or to switch from an off-exchange plan to an on-exchange plan. This flexibility is particularly important in order to allow people to take advantage of the enhanced premium subsidies created by the American Rescue Plan.

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Jack Mills
Jack Mills
21 days ago

I have been turned down for medical insurance, telling me I do not qualify for insurance in my home state. I am under the limit but was told I make too much, employer does not offer medical insurance. I have medical issues. Local hospitals tell me don’t visit them without insurance.

Louise Norris
Editor
21 days ago
Reply to  Jack Mills

Jack, you can normally only enroll in health coverage during the annual open enrollment period in the fall (starts November 1 each year) or during a special enrollment period triggered by a qualifying life event, such as losing an employer’s plan, having a baby, etc. But there is a one-time enrollment window happening in 2021 because of COVID and the American Rescue Plan, and it’s currently still underway in every state except Idaho: https://www.healthinsurance.org/blog/biden-administration-announces-three-month-special-enrollment-period/

So as long as you’re lawfully present in the US, not enrolled in Medicare, and not incarcerated, you can enroll in a health plan through the marketplace in your state, even if you don’t have a qualifying event (if you’re in Idaho, you’ll need a qualifying event).

Premium subsidies are available depending on your income. But there are 13 states (soon to be 11) where no financial assistance is available if your income is under the poverty level. It’s possible this is what you’re referring to when you say you’ve been turned down for insurance? If so, you’re still allowed to buy coverage, but you wouldn’t qualify for financial assistance. To be clear, those states have opted for that by not expanding Medicaid; the ACA called for Medicaid for everyone in that position, but some states have refused to implement it. Here’s more on the Medicaid coverage gap, in case that’s what’s going on: https://www.healthinsurance.org/faqs/what-is-the-medicaid-coverage-gap-and-who-does-it-affect/

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