If you've ever been told you have high blood pressure, managed diabetes, struggled with anxiety, or even dealt with acne that required treatment, you have what health insurers call a pre-existing condition. And here's the reality: about half of all Americans under 65 have at least one. So if you're worried about whether you can get health insurance coverage in 2026, you're definitely not alone.
The good news is that thanks to the Affordable Care Act, getting coverage with a pre-existing condition is easier than it's ever been. But there are some important traps to avoid, especially with the rise of non-ACA plans that don't have to play by the same rules. Let's break down exactly what you need to know to protect yourself and find the right coverage.
What Actually Counts as a Pre-Existing Condition?
A pre-existing condition is any health problem you had before the date your new health coverage starts. Insurance companies historically used two definitions to identify these conditions. The objective standard looks at anything you received medical advice or treatment for before enrolling. The prudent person standard is broader, covering anything where symptoms were present and a reasonable person would have sought treatment.
The list of what qualifies is surprisingly long. Chronic conditions like many forms of cancer, diabetes, lupus, epilepsy, and depression definitely count. But so do less severe issues like asthma, sleep apnea, and anxiety disorders. Even pregnancy before you enrolled is considered a pre-existing condition. If you had surgery, broke a bone, or needed ongoing treatment for any health issue before your coverage began, that's pre-existing too.
The thing that surprises most people is how common these conditions are. High blood pressure, high cholesterol, back problems, arthritis—these everyday health issues all qualify. If you've seen a doctor for it, it's likely a pre-existing condition from an insurance perspective.
How the ACA's Guaranteed Issue Protections Work
Here's where things get really good for anyone with health issues. The Affordable Care Act includes what's called guaranteed issue provisions, and they fundamentally changed how insurance companies have to treat pre-existing conditions. Under these rules, insurance companies cannot deny you coverage based on your health history. They can't charge you higher premiums because you have diabetes or cancer or any other condition. And they can't refuse to cover treatment for your pre-existing conditions.
This is huge. Before the ACA, insurance companies could look at your medical history and simply say no. Or they'd offer you a plan but exclude coverage for your existing conditions, sometimes permanently. Or they'd quote you a premium so high it was basically the same as denying coverage. None of that is legal anymore with ACA-compliant plans.
ACA plans can only vary your premium based on four factors: your age, whether you use tobacco, your family size, and where you live. Your health status isn't one of them. This means someone with multiple chronic conditions pays the same premium as someone the same age with perfect health. The coverage also comes with guaranteed renewability, meaning insurers can't cancel your plan just because you start using more care.
These protections apply to all marketplace plans you buy through Healthcare.gov or your state exchange, as well as most individual plans sold outside the marketplace and employer-sponsored group plans. As of 2026, these core ACA protections remain in place despite ongoing political debates about the law's future.
The Non-ACA Plan Trap: Why Short-Term Plans Are Risky
Now for the part that catches people off guard. Not all health insurance plans have to follow ACA rules. Short-term health plans, sometimes called short-term limited duration insurance, are the biggest example. These plans are designed to fill temporary gaps in coverage, like if you're between jobs or waiting for other coverage to start. They're usually cheaper than ACA plans, which makes them tempting. But if you have any pre-existing conditions, they're almost always a terrible deal.
Short-term plans can legally deny you coverage if you have pre-existing conditions. They can charge you more based on your health history. And even if they do accept you, they'll typically exclude coverage for any pre-existing conditions you have. That means if you have diabetes, your plan won't cover your insulin or doctor visits related to diabetes management. If you have asthma, they won't cover your inhaler or treatments for asthma attacks.
These plans use something called a look-back period to identify pre-existing conditions. The length varies by state and insurer, ranging anywhere from the previous six months to five years. They'll review your medical history during that look-back period, and anything you were diagnosed with or treated for gets excluded from coverage. Even conditions like high cholesterol or high blood pressure that millions of Americans manage with inexpensive medications can trigger exclusions.
While 2024 regulations introduced some new consumer protections and enhanced disclosures for short-term plans, the fundamental issue remains: these plans can exclude your pre-existing conditions from coverage. The lower premiums aren't a bargain if the plan won't cover the care you actually need.
Why Continuous Coverage Matters
One of the most important things you can do is maintain continuous health insurance coverage. Research shows that people who experience gaps in coverage are two to three times more likely to have problems accessing care and paying medical bills compared to those with continuous coverage. Even if you have insurance now, a gap in your coverage history can create problems down the road.
Here's why this matters with pre-existing conditions. While ACA plans have to cover you regardless of gaps, if you ever need or want a non-ACA plan for some reason, those coverage gaps can be used against you. Insurers can point to periods where you were uninsured and argue that conditions diagnosed during those gaps shouldn't be covered. Some employer plans and other coverage types may also have provisions related to prior coverage.
More importantly, gaps in coverage mean gaps in care. If you're managing a chronic condition, interruptions in treatment can make it worse. What started as well-controlled diabetes or hypertension can become a serious health crisis without consistent access to medications and doctor visits. The financial consequences of letting conditions worsen far exceed the cost of maintaining coverage.
How to Get Coverage with Pre-Existing Conditions
If you have pre-existing conditions and need health insurance, your best bet is an ACA-compliant plan. You can shop for these during the annual open enrollment period, which typically runs from November through mid-January for coverage starting January 1st. You may also qualify for a special enrollment period if you've experienced certain life events like losing other coverage, getting married, having a baby, or moving to a new state.
Start by visiting Healthcare.gov or your state's health insurance marketplace. You'll answer questions about your household size and income to see if you qualify for premium tax credits or cost-sharing reductions that can make coverage more affordable. The application won't ask about your health history or pre-existing conditions because they can't be used to deny you or charge you more.
When comparing plans, look carefully at prescription drug coverage if you take ongoing medications. Check whether your current doctors and specialists are in-network. Review the summary of benefits to make sure treatments you need regularly are covered. The premium is important, but so are your deductible, copays, and out-of-pocket maximum, especially if you know you'll be using your insurance frequently.
Having a pre-existing condition doesn't mean you can't get quality, affordable health insurance in 2026. The ACA's protections ensure you can't be denied or charged more because of your health history. Just be careful to stick with ACA-compliant plans and avoid short-term insurance that can exclude coverage for the conditions you actually need to manage. When you're ready to enroll, comparing quotes from multiple insurers will help you find the best coverage for your situation and budget.
