Pre-Existing Conditions and Medicare Supplements
Many people wonder how a pre-existing condition and Medicare will be handled once they move into Medicare. Will it be covered, will I get charged more, will the plan I enroll in deny my application and what happens if you get accepted with a pre-existing condition? There are a lot of factors that play into the answers to these questions. In this article we will do our best to help you understand what a pre-existing condition is and how it will affect you and your coverage when you enter into Medicare. After looking over this article give us at call or text at 866-319-5886 and we can answer any questions you may still have or help you get signed up with a plan that works for you.
What Is a Pre-Existing Condition?
A pre-existing condition is a medical condition that started before a person’s health benefits went into effect. For example if you were diagnosed with cancer on April 24th and your coverage did not start until May 1st. That would be considered a pre-existing condition. Here are some examples that might come up during underwriting:
- Diabetes requiring insulin or with complications
- Bone marrow or organ transplant
- AIDS or HIV
- Cancer
- ALS or MS
- Heart attack or congestive heart failure
- COPD
- Asthma
- Advice for a surgery that has not yet been performed
Enrolling Into a Medigap Plan
The best time to enroll into a Medigap plan is during the Medicare supplement open enrollment period. During this time, insurance companies can not use underwriting to deny you coverage based on any pre-existing health conditions. This is a 6 month window starting on the first day of the month you turn 65 or older and have enrolled into Part B of Medicare. The insurance company also can’t charge you more due to your health as well. Once that one time 6 month enrollment period is over you will be subject to medical underwriting for any Medigap Plan.
There are a few times where there may be special exceptions where you still may be able to get a Medigap plan without medical underwriting. This is called Guaranteed Issue and only applies in certain circumstances. Give us a call or text at 866-319-5886 and we will be happy to answer your questions.
Will a Pre-Existing Condition Stop Me From Getting Coverage?
There will be times that certain health conditions will cause your application for a Medicare Supplement to be denied. This is why we always suggest that our customers NEVER cancel their current plan until they have been approved by the insurance company they are applying with.
When you are not applying during a guarantee issue or Medicare supplement open enrollment period, there is always a chance that you may not qualify for a plan due to medical underwriting. Sometimes it can be due to just one thing and at other times it could be multiple things working together that will cause your application to be denied. Don’t always assume that because you have diabetes or had cancer years ago that you won’t qualify for a Medigap plan. The best thing you can do is give us a call or text and we can pre-qualify you before ever doing an application. Sometimes we might have to call the insurer to check but it is always worth asking before assuming you can’t get coverage.
Pre-Existing Condition Waiting Period
Applying during the Medicare Supplement Open Enrollment Period usually means that you will not have to wait for your coverage to start with your Medigap plan. There are times when you may have to go through a “Pre-existing waiting period”. During this time frame the Medigap plan will not cover you and you will have to pay all of your out-of-pocket costs for up to six months. Once the waiting period is over the Medicare supplement plan will start to help cover your out of pocket costs that relate to that pre-existing condition.
Many times during the application process you will be asked about your previous health insurance. If you are able to provide that you had creditable insurance for at least six months you may be able to avoid the pre-existing condition waiting period.
What happens during the waiting period?
Medicare Part A and Part B will still cover you during this time even while the Medicare supplement may not. This means that you will still be responsible for your portion of the cost sharing after Part A and Part B have covered their portions. For example if you were in a car accident the Medigap plan may help cover those expenses because that would not be considered a pre-existing condition. On the other hand, if you were admitted to the hospital due to an underlying heart condition that you had been getting treatment for, you will be responsible for your cost sharing and out of pocket expenses.
Pre-Existing Conditions and Medicare Summary
So we have covered a few things here that will hopefully help you answer some of the questions you have had. Again a pre-existing condition would be a health condition you had before your new health plan begins.
Just because you have a medical history does not mean that you are instantly going to be denied. Also, just because one company will not work with you does not mean another company may not be a better option. This blog was designed and written to help you better understand what a pre-existing condition is and how you may be affected. There are so many scenarios and variables that you will always want to call an agent or broker to see exactly what will be your best options.
The best time to enroll into a Medigap plan will be when you first become eligible because of the Medicare supplement open enrollment period. If you are not sure what to do still give us a call or text us at 866-319-5886.
Here is a list of states we are licensed in. If you don’t see your state still contact us as we are always adding more states and have a partner that works with over 40 states.