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Find out how to get covered with a pre-existing condition here.

As a result of the Affordable Care Act (ACA), you may now get medical coverage in Wisconsin even if you have a pre-existing condition. The law also states that health insurance companies can’t charge you more because of a pre-existing condition.

This is very good news for people who may have long-term health problems such as asthma, hypertension, diabetes or cancer. Even if you’ve been denied coverage in the past, insurance companies must provide you with medical insurance coverage. Those with pre-existing conditions will generally not face special insurance coverage conditions. Therefore, like everyone else with health insurance, they may also be expected to pay deductibles, copayments and coinsurance costs, and they may need to use network doctors and facilities or pay the full price for out-of-network treatment.

Find out how to get medical coverage with a pre-existing condition in Wisconsin.

If you already have medical coverage and develop a serious health problem, WI insurance companies may not cancel or deny you from covered medical treatment outlined in your plan.

An exception to the ACA’s pre-existing condition health coverage rule


Some people may have grandfathered individual health insurance plans, which do not have to provide medical coverage for pre-existing conditions. These grandfathered plans are those that were in existence on March 23, 2010 and haven’t been changed substantially since. So, if you’ve been on the same plan since 2010, it’s a good idea to find out if your plan has grandfather status.

 If you do have a grandfathered individual plan, the plan may continue to have yearly limits on coverage, so it’s very important to know (if you have a grandfathered plan, your insurance company should have notified you). If you are concerned about your insurance coverage, check your health plan materials, or call your insurance company today. 

What to do if your medical insurance coverage is grandfathered 

Review the materials to see if the plan has annual limits on coverage. If so, you may want to shop for a different plan during the next open enrollment period that includes the coverage you need.

 Ready to look for a new plan? Choose Quartz Benefits for medical coverage that includes access to UW Health Hospital and Clinics as well as a wide range of doctors and specialists in central Wisconsin. Shop our wide variety of health plans and get a quote today