Now that the ACA has been implemented, most people are no longer subject to pre-existing condition exclusion periods.
Practically any medical issue could fall under the umbrella of a pre-existing condition in the pre-ACA days.
Such chronic health problems that affect a large portion of the population were all considered to be pre-existing conditions.
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This was a waiting period before coverage would be provided for anything related to the pre-existing condition.
But some individual market plans did come with pre-existing condition exclusions for only a limited time.
In the individual market, HIPAA’s restrictions generally didn’t apply.
This has been the case since 2014 when the bulk of the ACA was implemented.
)Also, note that large employers tend to self-insure rather than buy health insurance from an insurance company.
Grandmothered and grandfathered (pre-ACA) plans purchased in the individual market are different though.
But if an existing enrollee already had a pre-existing condition exclusion, it can continue to apply indefinitely.
Pre-Existing Condition Exclusions and Medicare
Medicare covers pre-existing conditions, with no waiting periods.
However,Medicare supplemental insurance(Medigap) can impose pre-existing condition waiting periods in some cases.
With any health plan, it’s always a good idea to carefully read the fine print.
But that’s especially true if you’re buying a plan that’s not considered minimum essential coverage.
Focus on Health Reform.Health Insurance Market Reforms: Guaranteed Issue.
Centers for Medicare and Medicaid Services.The Health Insurance Portability and Accountability Act (HIPAA).
U.S. Department of Health & Human Services.Pre-Existing Conditions.
U.S. Department of Labor.
Employee Benefits Security Administration.Ninety-Day Waiting Period Limitation.
Centers for Medicare and Medicaid Services.Market Rating Reforms.
Colorado General Assembly.SB24-073 Maximum Number of Employees to Qualify as Small Employer.
Enacted May 1, 2024.
KFF.2023 Employer Health Benefits Survey.
medicareresources.org.Is there a best time to enroll in a Medicare supplement plan?
Medicare.gov.Get ready to buy.
July 26, 2023.
