Understanding Medicare plans can be a complex task, especially if you have pre-existing conditions. When it comes to Medicare plans, pre-existing conditions are defined as any problem or health issue you have prior to the start date of a new health insurance plan. You cannot be denied Original Medicare coverage due to pre-existing conditions. Medicare Advantage plans legally must offer the same coverage as Original Medicare; however, Medicare Advantage coverage for specific treatments related to your condition may be limited, and network restrictions may apply. In this article, we’ll help you understand Medicare Advantage coverage for individuals with pre-existing conditions and how to navigate the intricacies of your plan.
Medicare Plan Coverage for Pre-Existing Conditions
Applying for a Medicare plan with a pre-existing condition will likely bring up concerns about your coverage eligibility, but don’t worry. When it comes to Medicare plans and pre-existing conditions, Original Medicare and Medicare Advantage plans won’t reject your application because of a previous health condition. Previously, Medicare Advantage plans didn’t cover certain pre-existing conditions, like end-stage renal disease (ESRD). However, after a policy change went into effect on January 1, 2021, those with ESRD can now enroll in Medicare Advantage plans.
Do Medigap Plans cover pre-existing conditions?
Medigap plans, also called Medicare Supplement plans, may provide coverage for pre-existing conditions. Medigap plans are designed to work alongside Original Medicare (Parts A and B) and help cover out-of-pocket costs, such as deductibles, copayments, and coinsurance. It’s important to note that not all states have the same rules regarding pre-existing conditions and Medigap plan coverage. If you have questions about a specific Medigap plan’s coverage for pre-existing conditions, consult the carrier or your insurance agent.
When can you apply for Medigap plan coverage if you have pre-existing conditions?
When it comes to pre-existing conditions, there are certain rules that apply during the initial enrollment period. During the six-month Medigap Open Enrollment Period, which begins when you are 65 or older and enrolled in Medicare Part B, insurance companies are generally required to offer you a Medigap policy regardless of your pre-existing conditions. They cannot deny you coverage or charge you higher premiums based on your health status. If you want to shorten your pre-existing condition waiting period, you should buy a policy during your open enrollment period. During this time, Medigap policies must shorten any pre-existing condition waiting period by the number of months you had prior creditable coverage.
However, if you apply for a Medigap policy outside of the Open Enrollment Period, insurance companies may be allowed to impose waiting periods if you have pre-existing conditions. This means they may delay coverage for services related to your pre-existing condition for up to six months. After the waiting period, the Medigap plan will cover the costs associated with your pre-existing condition.
Navigate Medicare Advantage Coverage with SelectQuote
When you have pre-existing conditions, navigating the intricacies of Medicare Plans can feel overwhelming. Fortunately, SelectQuote is here to help you understand your eligibility and find Medicare Advantage Plans available in your area that may include additional routine benefits. Our licensed, experienced insurance agents will walk you through your options and help you compare Medicare Advantage plans in just minutes. They’ll guide you through exploring benefits and plan details so you can find the coverage that works best for you.
