Guaranteed Issue

Acceptance without health questions

Guaranteed issue is a rule that requires insurers to offer coverage to every eligible applicant. They cannot turn you down because of a medical condition, past claims or current treatment.

Under the Affordable Care Act, all ACA-compliant individual and small group plans are guaranteed issue. That is a big part of why pre-existing conditions are covered from day one.

The catch: timing

Guaranteed issue only applies during an enrollment window:

• Open enrollment, which for 2027 coverage runs November 1, 2026 to January 15, 2027 on HealthCare.gov.
• A special enrollment period, usually 60 days after a qualifying life event like losing other coverage, moving or having a baby.

Outside those windows, you generally cannot enroll in an ACA plan, even though the plan would be guaranteed issue if you could.

Example

Lauren, a self-employed designer, skipped coverage in 2026. In March 2027 she is diagnosed with a condition that needs ongoing treatment. Open enrollment ended January 15, and she has no qualifying life event.

• She cannot enroll in an ACA plan until open enrollment for 2028 unless she has a qualifying event.
• Private underwritten plans may decline her because of the new diagnosis.
• Short-term plans would exclude the condition.

Had she enrolled during open enrollment, she would have been guaranteed coverage. Guaranteed issue protects you only if you use the windows.

Guaranteed issue vs guaranteed renewable

These sound similar but mean different things:

• Guaranteed issue: the insurer must accept your application.
• Guaranteed renewable: once covered, the insurer must let you renew, as long as you pay premiums and the plan is still offered.

ACA-compliant plans have both. Some private plans are guaranteed renewable but not guaranteed issue, meaning acceptance requires underwriting, but once approved you can keep renewing.

Marketplace vs private plans

Every Marketplace plan is guaranteed issue during enrollment periods, and so is every ACA-compliant plan sold off the exchange. Private plans outside the ACA rules are typically medically underwritten, so acceptance is not guaranteed. The advantage of private plans is that you can apply year-round; the trade-off is that a health condition can block approval.

Using this to your advantage

• Do not let coverage lapse if you have health concerns. Enroll during open enrollment.
• If you are healthy and miss the window, a private plan may bridge the gap until the next open enrollment.
• Track your qualifying life events, since each one opens a guaranteed issue window.

See our guides on missed open enrollment and Florida individual health insurance for next steps. If you need coverage now, request a quote.