Medicare & Pre-Existing Conditions – What You Need to Know

A pre-existing condition is defined as a health condition that exists before you begin receiving healthcare coverage. Pre-existing conditions can encompass both injuries and illnesses. Examples of pre-existing conditions include asthma, arthritis, cancer and heart disease.

As pre-existing conditions are broadly defined, many individuals are considered to have pre-existing conditions. Indeed, most Medicare eligible individuals have pre-existing conditions.

The Centers for Medicare and Medicaid Services has estimated that up to 86% of Americans between ages 55 to 64 have a pre-existing condition.

You may not be denied Medicare coverage due to a pre-existing condition. However, pre-existing conditions can affect your ability to obtain Medicare Supplement insurance.

Open Enrollment Periods – Don’t miss the deadline for those with pre-existing conditions!

The six-month period that begins when you turn 65 and are enrolled in Medicare Part B, otherwise known as your Open Enrollment Period, is a critical time for those with pre-existing conditions.

During your Open Enrollment Period—and only during your Open Enrollment Period—you may not be denied Medicare Supplement coverage due to a pre-existing condition.

There are other benefits to obtaining Medicare Supplement coverage during your Open Enrollment Period. Not only can you not be denied, insurers are prevented from charging you increased premiums due to a pre-existing condition if you enroll during the Open Enrollment Period. Any pre-existing condition will also be covered on your effective date, with no look-back period.

What if I have a pre-existing condition and missed my Open Enrollment Period?

You may still be able to obtain Medicare Supplement coverage with a pre-existing condition even after your open enrollment period. You may even qualify for Medicare Supplement coverage even if you have previously been denied coverage due to a pre-existing condition. Each private insurer can establish its own underwriting guidelines. This means that a condition that disqualifies you from one plan may not disqualify you from all supplement plans.

There are certain drawbacks to enrolling after your Open Enrollment Period, even if you find a plan that accepts your membership application. Your insurer may impose a “look-back period” (sometimes know as a “pre-existing waiting period”) of up to six months before covering your pre-existing condition when enrolling after your Open Enrollment Period. This look-back period may be waived if you have had at least 6 months of creditable coverage prior to applying for a Medicare Supplement plan.

You may also be subject to medical underwriting if you have a pre-existing condition and do not sign up for a Medicare Supplement plan during your Open Enrollment Period. Medical underwriting is the process by which a health insurer uses your medical history to determine your coverage and premiums.

While we cannot guarantee that we can find you Medicare Supplement coverage for a pre-existing condition once your Open Enrollment Period has closed, we will work with you to find the best options to fit your budget and healthcare needs, whether in the form a Medicare Supplement plan or otherwise.