Pre-existing conditions covered no matter where you buy the plan

If you buy a health insurance plan directly from the insurance company rather than through the state insurance exchange, are you still covered for pre-existing conditions as per the Affordable Care Act?

Considering Options

Dear Considering Options,

Where you buy your health insurance plan does not matter, as long as you are buying a “qualified health plan”.  A qualified health plan meets all of the Affordable Care Act requirements, which as you note include covering pre-existing conditions.  Only qualified plans can be sold over the insurance exchanges.

Some insurers might be selling plans that do not meet the requirements.  For example, a plan that covers only emergency care or accidents.  These plans are often called “supplements”.  These would not be sold on the insurance exchanges.

So, while it’s possible to buy a plan directly from an insurer that does not cover pre-existing conditions, it would be clearly marked as a non-qualified health plan.  In other words, you are not likely to buy one of these plans by accident even if you do not go through the insurance exchange.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.