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.