Guaranteed Issue

Guaranteed issue means an insurer must sell you a policy regardless of your health, and cannot decline the application because of a condition, a prescription, or your medical history. Since 2014, all ACA-compliant individual and small-group plans are guaranteed issue, and employer group plans have been for larger groups since the 1990s.

Guaranteed issue only works alongside two other rules. Community rating stops the insurer from charging a sick person more, and enrollment periods stop people from buying coverage on the way to the hospital and dropping it on the way home. Without the enrollment limits, guaranteed issue would collapse the risk pool, which is what happened in a few states that tried it in the 1990s without them: New York's individual market premiums roughly tripled. Medicare supplement plans are guaranteed issue for six months after you enroll in Part B, and in most states can be underwritten after that, which surprises people who try to switch plans at 72.

The takeaway: guaranteed issue is a right that comes with a calendar. Use the open enrollment or special enrollment window, because outside of it the guarantee may not apply.