A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Call our agency partners 866-553-3223
Call our agency partners 866-553-3223
A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Featured
How sunsetting ARP’s subsidy enhancements would affect ACA subsidy amounts
What will happen to Marketplace health insurance subsidy availability and size when the subsidy enhancements instituted under the American Rescue Plan sunset after 2025?
Featured
Where do I find my 1095 tax form?
The 1095 tax forms are used by exchanges, employers, and health insurance companies, to report health insurance coverage to the IRS. Learn about each type of health insurance tax form and where to find it.

guaranteed issue

Infographic regarding guaranteed issue

What is guaranteed issue?

Guaranteed issue refers to health insurance coverage that is guaranteed to be issued to applicants regardless of their health status, claims history, age, gender, or other underwriting factors.

Prior to 2014, individual market health insurance (the kind you buy on your own, rather than obtaining from an employer) was typically not guaranteed issue. Instead, insurers in most states based eligibility on an applicant's medical history. But that changed when the bulk of the Affordable Care Act's provisions were implemented in 2014.

All individual-market major medical plans in all states are now guaranteed issue, and applicants' medical history is no longer a factor in their eligibility. The trade-off is that enrollment is now limited to one annual open enrollment period, and special enrollment periods that are mostly triggered by qualifying life events. Whereas prior to 2014, people could apply for individual market coverage at any time, but eligibility in most states was contingent on medical history.

The guaranteed-issue requirement and the limited enrollment windows apply both on-exchange (through the Marketplace) and off-exchange.

Are Medicare and Medicaid guaranteed-issue?

Yes, Medicare and Medicaid are guaranteed-issue, for anyone who meets the eligibility criteria. For Medicare, this includes being at least 65 or having a long-term disability, and for Medicaid, there are income limits for all applicants, age, pregnancy, or disability requirements for some populations, as well as asset limits for some populations.

Both programs also have rules requiring most non-citizens to be lawfully present in the U.S. for at least five years before being eligible for coverage.

But anyone who meets the overall eligibility requirements can enroll, regardless of their medical history.

Get your free quote now through licensed agency partners!

sticky-bottom-cta
close