What if I have a pre-existing condition?
A pre-existing condition is a health problem you had before your coverage starts, such as asthma, diabetes, cancer or pregnancy.
ACA plans cannot:
- Turn you down because of your health
- Charge you more because of your health or your gender
- Refuse to cover treatment for a condition you had before you enrolled
This applies to all Marketplace plans, to ACA plans sold outside the Marketplace, and to most job-based plans. Medicaid and CHIP also cover pre-existing conditions.
Not all health products have these protections. Short-term health plans, fixed indemnity plans and older "grandfathered" individual plans can exclude pre-existing conditions or charge more for them. Ask your agent whether a plan is ACA-compliant before you buy.
What if I'm pregnant or adopting a child?
Pregnancy counts as a pre-existing condition, so an ACA plan can't deny you or charge you more for it. Under federal rules, being pregnant does not open a Special Enrollment Period. A few states allow it, so check your state's Marketplace. Otherwise, you can enroll during Open Enrollment or with another qualifying event.
Birth, adoption, or foster placement opens a Special Enrollment Period. You have 60 days to enroll or change plans. Coverage can start on the date of the birth, adoption or placement.
What about grandfathered plans?
A grandfathered plan is an individual plan bought on or before March 23, 2010, that hasn't changed much since. These plans don't have to follow the ACA's pre-existing condition rules.
You can switch to a Marketplace plan during Open Enrollment. If your plan's year doesn't follow the calendar year, its renewal date also gives you a Special Enrollment Period to switch.
Last reviewed October 2026. Rules can change and can vary by state; this page is general information, not legal or tax advice.