Pre-Existing Conditions and the Affordable Care Act

New Rules Are Far Fairer for Patients with Pre-Existing Conditions

Little Boy Holding Obamacare Sign
Mehmed Zelkovic/Getty Images

Updated: March 2013

Unless they were lucky enough to have an employer to provide them with health insurance coverage, Americans with pre-existing conditions struggled for many years to find health insurance to help them pay for the care they needed. That often left them vulnerable, unable to afford the medicine or other treatment they needed, perhaps leading to further sickness, pain, debilitation or even death.

In 2010, with passage of the Affordable Care Act (also known as healthcare reform or Obamacare) the tide began to shift for these patients. The law makes it illegal for health insurance companies to simply deny insurance to any applicant with a pre-existing condition. Further, insurers cannot charge any more for that applicants' health insurance than they would any healthy applicant.

The requirement for insurers to cover children with pre-existing conditions was implemented soon after passage of the new law. Children can no longer be denied coverage by the insurer who covers their parents and must now be included in family coverage. (There are some exceptions. See information about "grandfathered" plans.)

The part of the law that covers adults with pre-existing conditions will not be in force until 2014. However, the government put together an interim program to help these patients.

That program was called PCIP - the Pre-Existing Condition Insurance Plan.

From the time it was implemented until early 2013, it was available to the millions of Americans with pre-existing conditions who did not have the benefit of employer-based insurance.

However, in February 2013, the plan was closed to any new applicants because funding could no longer be guaranteed. You can find the government's statement regarding closing the PCIP plan to new enrollees at its website.

What Will Change for Patient With Pre-Existing Conditions?

Once January 1, 2014, rolls around, PCIP plans will no longer exist for anyone who has them now. There will be no need for PCIP because pricing distinctions between those with, or without, pre-existing conditions will be illegal.

By Fall 2013, new plans will become available through each state's health exchange program, and patients with pre-existing conditions will be able to take advantage of the lower costs that will accompany those exchanges. All patients who need individual health insurance will make their choice for 2014 and beyond from those new plans.

Learn more about the ACA's plan for patients with pre-existing conditions.

• Check out other highlights of the Affordable Care Act (ObamaCare) and how they may affect you.

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