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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.

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

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.

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Jack Mills
Jack Mills
3 months 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
3 months 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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