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Does Medicare Cover Pre-Existing Conditions?

Lots of healthy people enroll in Medicare every year, but lots of unhealthy people do as well. For those who have less than optimal health, there is one question we always get asked: Does Medicare cover pre-existing conditions?

Rest assured, pre-existing conditions are covered by Medicare. There won’t be any restrictions or waiting periods on the care you’re allowed to receive. That being said, there are a few things you should know about pre-existing conditions as you transition into Medicare.

Pre-Existing Conditions and Medicare: What’s Covered

The first opportunity you have to enroll in Medicare (assuming you’re aging into Medicare as you turn 65) is during your Initial Enrollment Period or IEP. This is a 7-month window that begins three full months prior to your birthday month. During this time, you can enroll in Medicare as well as any other Medicare plans you may need.

If you have chronic conditions and need frequent medical care, we’d also recommend enrolling in a Medigap policy, also known as a Medicare Supplement plan. You have an 8-month Medigap open enrollment period that begins on your Part B effective date. During those eight months, you can enroll in any Medigap plan in your area, no questions asked.

Both Original Medicare (Parts A and B) and your Medigap plan will cover all your pre-existing conditions. They will not require a waiting period or have any restrictions other than the standard ones imposed by the federal Medicare program.

Doctor talking with patient about how Medicare covers pre-existing conditions

Why You Need to Choose the Right Medicare Plan

When choosing your Medicare Supplement coverage, your current health is something to consider. While Original Medicare won’t ask you any health questions on your application regardless of when you apply, Medigap carriers can accept or decline your application if you miss your one-time Medigap open enrollment period.

Of course, you can also choose to go down the Medicare Advantage path instead of enrolling in Medigap. We often see people do this because it is the cheaper, up-front option. This often results in many out-of-pocket costs down the road. Let’s look at why this is the case.

Medicare Supplements have higher monthly premiums and little to no out-of-pocket costs. Medicare Advantage plans have much lower premiums (sometimes as low as $0 per month) but higher out-of-pocket costs when you need to use the plan. There is a trade-off in either case.

Pre-existing Conditions When Switching Medigap Plans

Beneficiaries grappling with existing health conditions may contemplate moving from a Medicare Advantage plan to a Medigap plan or shifting between Medigap policies. In many states, this transition means answering health questions, which could result in a denial from the insurance carrier.

If there's a concern that a pre-existing health condition might impede future Medigap plan accessibility, it becomes paramount to choose comprehensive coverage from the onset of your Medicare coverage.

Each insurance company has its own set of regulations and medical evaluation criteria. If you work with an experienced Medicare insurance broker, they’ll be able to tell you which companies may approve your application.

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