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.
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:
- Prohibiting insurers from rescinding your coverage because of an unintentional mistake on an application
- Banning insurers from setting lifetime or annual dollar limits on your coverage
- Ensuring you can choose the primary care doctor you want from your plan’s list (note that if your plan is an HMO or POS, you’ll likely be required to select a primary care doctor and get referrals from that doctor for specialist visits)
- Allowing children under 26 to remain on their parents’ policy
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.