Will pre existing conditions be covered by Blue Cross Blue Shield?
Short answer
Insurance question
Yes, for ACA-compliant BCBS plans. Under the Affordable Care Act, insurers — including Blue Cross Blue Shield — cannot deny enrollment, charge higher premiums, or exclude coverage for pre-existing conditions such as asthma, diabetes, cancer, or heart disease. This applies to Marketplace and most employer plans.
This is an independent research summary, not official coverage information. Your plan is the final word.
Key facts
Under the ACA, insurers cannot deny coverage or charge more for pre-existing conditions in Marketplace and most employer plans.
ACA community rating: premiums can only vary by age, location, plan tier, and tobacco use — not health status.
Short-term plans and grandfathered plans may not be subject to ACA pre-existing condition protections.
Here's the nuance
A one-liner rarely tells the whole story. This is the honest detail behind the short answer above.
The Affordable Care Act (ACA) established guaranteed issue and community rating rules that fundamentally changed how pre-existing conditions are handled by health insurers, including every BCBS company. Under these federal rules, any ACA-compliant plan — sold on a state or federal Marketplace, or offered by most employers — must accept you regardless of your health history and must cover your pre-existing condition on the same terms as any other covered condition. Premiums under ACA-compliant plans can vary only by age (within set limits), geographic area, and tobacco use — not by health status or diagnosis.
Pre-existing conditions covered under this protection include virtually any health issue that existed before your coverage began: allergies, asthma, diabetes, cancer history, heart disease, pregnancy, mental health conditions, and more. There are no waiting periods for pre-existing conditions in ACA-compliant plans.
However, not every plan type is ACA-compliant. Short-term health plans, grandfathered plans (older plans that predated the ACA and have not made significant changes), and some association health plans may still be able to exclude pre-existing conditions or charge more based on health status, depending on state law. If you are enrolled in one of these plan types through BCBS, the ACA's pre-existing condition protections may not fully apply.
For most consumers buying BCBS coverage through the Marketplace (Healthcare.gov or a state exchange) or through a standard employer plan, pre-existing conditions will be covered. To confirm which protections apply to your specific BCBS plan, check your plan's Summary of Benefits and Coverage or contact Member Services.
The key points
The handful of things that decide the answer — skim these if you only read one section.
ACA-compliant BCBS plans cannot deny or restrict coverage for pre-existing conditions
Under the ACA, Marketplace and most employer-sponsored BCBS plans must enroll you regardless of your health history and must cover your pre-existing condition without higher premiums or benefit exclusions.
Premiums cannot be based on health status
ACA community rating rules mean that BCBS can only vary your premium based on age (within limits), location, plan tier, and tobacco use — not based on your medical history or pre-existing diagnosis.
No waiting periods for pre-existing conditions
ACA-compliant plans cannot impose a waiting period before covering a pre-existing condition. Coverage for your condition begins when your plan coverage begins.
Short-term and grandfathered plans may have different rules
Short-term health plans and grandfathered employer plans are not required to follow all ACA rules and may exclude pre-existing conditions or charge more based on health status. Confirm which type of plan you have.
BCBS is a federation — specific plan rules vary by state
There are 33 independent BCBS companies. While federal ACA rules set the floor, your state's insurance laws may provide additional protections. Check your Evidence of Coverage for your plan's specific terms.
Confirm before you rely on this
Coverage varies by plan — this is not official
Coverage rules, benefit tiers, and medical-necessity criteria change often and differ by plan type, state, employer, and your specific policy. This page is a general, independent research summary — it is not official information from any insurer, not a benefits determination, and not financial or insurance advice.
Verify your exact coverage by calling the member number on your insurance card or checking your plan documents before you rely on any answer here.
❓Frequently Asked Questions
No — not if you are enrolled in an ACA-compliant BCBS plan. Under the ACA's community rating rules, BCBS cannot charge you a higher premium because of a pre-existing condition such as asthma, allergies, or any other health diagnosis. Premiums can only vary by age, location, plan tier, and tobacco use. Short-term or grandfathered plans may operate differently.
Virtually any health condition that existed before your coverage start date can qualify as a pre-existing condition — including allergies, asthma, diabetes, heart disease, cancer, depression, arthritis, pregnancy, and more. Under ACA-compliant BCBS plans, none of these can be used to deny coverage, raise your premiums, or exclude that condition from benefits.
Yes, for ACA-compliant plans. There are no pre-existing condition exclusion periods under Marketplace or most employer BCBS plans. If your plan covers the type of treatment needed, coverage applies from day one — regardless of when the condition was diagnosed. Confirm your specific covered benefits in your plan documents.
Yes. Medicare Advantage plans — including those offered by BCBS — must cover all conditions that Original Medicare covers, and Original Medicare does not exclude pre-existing conditions. ACA guaranteed-issue rules also apply to Medicare Advantage plans. The plan cannot deny enrollment or restrict benefits based on pre-existing conditions during the annual enrollment period.
Short-term health plans are not required to comply with all ACA rules. Depending on your state and plan terms, a short-term BCBS plan may be able to exclude pre-existing conditions, charge higher premiums based on health status, or impose waiting periods. If you are unsure whether your plan is ACA-compliant, review your plan documents or call BCBS Member Services.
Reviewed by
Curex Editorial TeamReviewed for accuracy
Last reviewed July 2026
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Read moreYour plan has the final say
The surest way to know what's covered is to ask the source. Call the member number on your insurance card or sign in to your plan portal, and have the service or medication name ready — a quick call beats guessing.
This page is independent research, not a benefits determination — your insurer's answer is the one that counts.
This content is for general informational purposes only. It is not official coverage information, a benefits determination, or financial or insurance advice. Coverage rules, benefit tiers, and medical-necessity criteria change often and vary by plan, state, and effective date — always verify your specific benefits directly with your insurer before making any decision.