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

  • By
  • contributor
  • March 4, 2016

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

A: The main idea behind health care reform law 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 removes most of those barriers, so not only can a 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 ways, such as:

  • Prohibiting insurers from rescinding your coverage because of an unintentional mistake on an application
  • Banning insurers from setting lifetime 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, you’ll need 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

It’s important to understand, however, that health insurance is now 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.