The Health Insurance Portability and Accountability Act of 1996 or HIPAA is a law that protects millions of working Americans and their families who have medical conditions or who might have trouble getting medical insurance because of a medical condition that they had before they tried to buy health insurance (called a pre-existing condition).

Does the 2010 Affordable Care Act affect HIPAA?

The newer Affordable Care Act (ACA) passed in 2010 has or will change the way health insurance companies manage coverage for pre-existing conditions.

• The ACA does not allow insurance companies to deny coverage for pre-existing conditions (such as diabetes or cancer) in children as of September 2010. And starting in 2014, it will not allow denial of coverage of pre-existing conditions in adults
• The ACA says that each state must have a Pre-Existing Condition Insurance Plan (PCIP) for people who have not had insurance for 6 months or more and have cancer or another pre-existing condition. Whether the state or the US Department of Health and Human Services runs the PCIP program depends on the state. The program name and design also may vary depending on which state you live in. (Go to www.healthcare.gov/law/provisions/preexisting/index.html for the most current information on what is available in your state.)
• It will require all Americans to buy insurance and guarantee coverage regardless of a person's medical history starting in 2014.

But until 2014, adults with cancer or other pre-existing conditions are protected by the HIPAA laws, which we will explain here.

How does HIPAA help people with cancer?

The law includes several parts that may help cancer patients:

• It limits what is considered a pre-existing condition. An employer health plan can exclude a medical condition from coverage only if the person had a gap in coverage longer than 63 days, and also had or was recommended to have treatment or medical advice in the 6 months before enrolling in the plan.
• It limits the time a new employer plan can exclude the pre-existing condition from being covered. An employer health plan can avoid covering costs of medical care for a pre-existing condition for no more than 12 months after the person is accepted into the plan.
• It gives certain people the right to buy individual health insurance if no group health plan coverage is available, and the person has exhausted COBRA or other continuation coverage. (For more information on COBRA, see our document What is COBRA?) Certain conditions and time limits must be met.
• It does not allow employers or their health insurers to discriminate or act unfairly against employees and their dependents based on their health status or genetic information.
• It guarantees certain people the ability to get or renew individual health insurance coverage.

HIPAA also protects privacy and gives you more access to your medical records.

In 2002, the HIPAA laws were expanded to give patients greater access to their own medical records. The expanded law also gave patients more control over how their personally identifiable health information is used. In general, health information may not be shared without written permission of the patient. The law requires health care providers and health insurance plans to protect the privacy of patient health information, too. Medical records must be kept under lock and key and are available only on a need-to-know basis.

HIPAA sets a basic standard for health insurance in the US.

The rest of the information here is about how HIPAA may affect your health insurance. It is important to know that some states have laws that, although similar to HIPAA, may offer more generous protections. While HIPAA requires a minimum standard all over the US, you may want to contact your state insurance commissioner's office to learn more about the law where you live. See the "To learn more" section to get help finding your state's department of insurance or insurance commission.

What doesn't HIPAA do?

Even though HIPAA offers protections and makes it easier to switch jobs without fear of losing health coverage for a pre-existing condition, the law has limits. For instance, HIPAA:

• Does not require employers to offer health coverage
• Does not require employers that offer coverage for employees to also cover their families or dependents
• Does not guarantee that you can afford the health coverage that is offered
• Does not keep an employer from imposing a pre-existing condition exclusion period if you have been treated for a condition during the past 6 months and have had an interruption in your coverage
• Does not replace your state as the main regulator of insurance where you live

Even so, HIPAA may lower your chance of losing the coverage you have already. It usually makes it much easier to switch health plans or change jobs without losing coverage if you have a health problem. And it may help you buy coverage on your own if you lose your employer's plan and have no other coverage available -- but only if you meet certain requirements and take action in time to qualify.