Pre-Existing Condition Coverage Under COBRA
COBRA coverage does not have a pre-existing condition clause that would prevent you from receiving treatment. When you enroll in employer COBRA coverage, you are continuing the same group health insurance coverage you had with your former employer. As an Affordable Care Act–certified plan, your existing medical conditions will remain covered under your employer-sponsored plan.
What You Need to Know
- COBRA coverage does not exclude pre-existing conditions because it continues the same employer-sponsored health plan.
- Affordable Care Act marketplace plans cover pre-existing conditions and may cost less than COBRA, with subsidies available.
- The Affordable Care Act prohibits insurers from denying coverage, charging higher premiums, or limiting benefits for pre-existing conditions.
What Is a Pre-Existing Condition?
A pre-existing condition is any health issue that existed before the start date of your new health coverage. Common examples include:
- Asthma
- Diabetes
- Heart disease
- Cancer
- High blood pressure
- <a href="/kb/cobra-covers-pregnancy/"Pregnancy
Under COBRA and Affordable Care Act marketplace plans, pre-existing conditions remain covered without waiting periods or exclusions.
Changes Under the Affordable Care Act
Under the Affordable Care Act (ACA), health insurance companies are prohibited from charging extra, denying coverage, or limiting benefits for pre-existing conditions. This applies to all insured individuals, including those with conditions such as asthma, diabetes, cancer, or those who are pregnant. Furthermore, insurers are required to cover treatments for pre-existing conditions once coverage begins.
Find Coverage for Pre-Existing Conditions
The ACA, also known as Obamacare, and COBRA both offer solutions for individuals with pre-existing conditions.
- Marketplace Health Insurance: ACA plans are available through federal, state and private marketplaces and may be more affordable, especially for those eligible for subsidies. Explore ACA plans on the marketplaces.
- COBRA Coverage: COBRA allows you to continue your existing insurance coverage. While it provides continuity, it can be more expensive than ACA plans. Each option has specific eligibility criteria that can be met during your special enrollment period.
Short Term Medical Insurance Does Not Cover Pre-Existing Conditions
Short-term health insurance is an affordable alternatives to COBRA and typically do not cover pre-existing conditions. We recommend staying on your existing employer’s insurance if you expect major medical expenses while in between health plans.
Frequently Asked Questions
Yes. COBRA continues your employer-sponsored group health plan, and all pre-existing conditions remain covered without waiting periods or exclusions.
Yes. Under the Affordable Care Act, marketplace plans must cover pre-existing conditions and cannot charge higher premiums or deny coverage because of them.
ACA marketplace plans are usually less expensive than COBRA, and many people qualify for subsidies that can lower premiums to as little as $10 per month.
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