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Does Medicare cover pre-existing conditions?

A pre-existing condition is considered to be a health issue the you had prior to starting your new insurance plan. A lot of people are fortunate enough to be in good health when they enroll in Medicare. However, there are some that have chronic conditions and are unsure as to whether or not they will be covered when it’s time to enroll.

The good thing is that everyone gets to sign up for Medicare without a pre-existing health questionnaire. Medicare won’t reject you if you have current health problems. However, that does not mean that every treatment for a pre-existing condition is covered.

This rule regarding pre-existing conditions is a Federal law. If this was not in place, many people would delay retirement because of the fear Medicare won’t cover their current health issues

Original Medicare

Original Medicare covers all pre-existing conditions. When you enroll in Medicare, there are no pre-existing condition limitations or health questions. You can also enroll in Medigap coverage during your open enrollment window to ensure that your supplemental coverage will also cover pre-existing conditions.

Medicare Parts A, B & D

There are no Medicare pre-existing conditions restrictions for Parts A, B, or D.
Part A will cover any inpatient needs related to your pre-existing condition. Part B will cover any outpatient needs related to your pre-existing conditions. You can enroll in a Part D drug plan that covers the medications you are taking as well.

Supplemental Coverage

Medicare Supplement (Medigap) insurance plans are managed by private insurance companies and can help you pay for various out-of-pocket costs for services covered under Medicare Part A and Part B. The different Medicare supplement plans may pay for different amounts of those costs, including deductibles, copayments and coinsurance.

When choosing your Medicare supplemental coverage, your state of health is something to consider. Medicare doesn’t ask any health questions, but Medicare supplement companies have the option to review your medical history, charge you more, impose a waiting period or simply deny your application if you miss your one-time Medicare Supplement open enrollment period (OEP).

Your OEP is the 6-month period that starts the first month that you have Medicare Part B and are age 65 or over. The plan can’t turn you down or charge you more if you have a pre-existing condition.

Applying for Supplemental Coverage AFTER OEP

  • The insurer may make you wait up to six months before covering your pre-existing condition(s). This is known as the Medigap pre-existing condition waiting period.
  • Guaranteed-issue rights can apply – Ex: if you enrolled in a Medicare Advantage plan and have had it less than 12 months, a “trial right” may apply.

>>Related: Don’t Rely on Medicare for your Long-Term Care

Pay Attention to CoPays

If you have a chronic condition, copays on the Medicare Advantage plans can add up quickly. It is really important to determine what copays you expect to have regularly based on what you currently experience.

Understanding your costs fully can help you make the decision to opt for a more expensive Medigap plan. Additionally, if you get a Medicare Advantage plan up front, you may not qualify for a Medigap plan later. I can help you figure this out!

Each insurance company has its own rules and underwriting questions. That’s why it’s important to work with a Medicare insurance broker with various Medigap companies to choose from. A qualified broker specializing in Medicare will have the experience to help you evaluate your choices.

I hope this has helped to reduce some of your worries as to whether Medicare will cover your pre-existing condition. I am always here for you and happy to help with any questions you may have.

To get unbiased help with your Medicare decisions, feel free to reach out any time!
Brenda Gilliam, Your Medicare Insurance Agent & Extra Help Coordinator
Phone: 423-276-5807
Email: brenda@gilliaminsuranceadvisor.com

* Not affiliated with any government agency.
*We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.

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