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Does Medicare Cover Pre-Existing Health Conditions

Medicare isn’t dependent on the status of your health. Meaning pre-existing health conditions won’t impact eligibility as long as you apply at the right time. Below, we’ll go over what you need to know about pre-existing conditions and your Medicare coverage.

Medicare and Pre-Existing Conditions

When it comes to Medicare, there are no pre-existing condition limitations under Part A, Part B, or Part D. It doesn’t matter if you are completely healthy when you become Medicare eligible or have been diagnosed with a chronic condition, you don’t have to be concerned about being accepted into the federal health program. Original Medicare covers all pre-existing conditions.

Every beneficiary gets an enrollment window called your Initial Enrollment Period. At this time, you can enroll in Medicare without any health questions. Once you enroll in Part B, you’ll have another enrollment window that allows you to enroll in a supplemental plan without pre-existing conditions impacting your chances of being accepted into the plan.

Do Medicare Supplement Plans Cover Pre Existing Conditions?

Yes, Medicare Supplements cover pre-existing conditions as long as you enroll at the right time. When purchasing a Medicare Supplement plan during your Medigap Open Enrollment Period, you’re automatically eligible for coverage.

During this period, you’re granted Guaranteed Issue Rights. Private insurance companies offering Medigap plans cannot deny you coverage or increase your rates due to any pre-existing health conditions.

If you don’t enroll during your Open Enrollment Period, you can be denied coverage or charges a higher premium due to pre-existing health conditions.

If you enroll outside your OEP, you may have a waiting period before coverage will begin. They can only do this for 6 months. The pre-existing condition waiting period really only applies to Medigap plans.

Medicare will cover your pre-existing condition on covered services. However, for the first 6 months, 20% of out of pocket costs will be covered by you.

Do Medicare Advantage Plans Cover Pre Existing Conditions?

Yes, Medicare Advantage plans will cover pre-existing conditions. The only health questions on the application are regarding End-Stage Renal Disease. ESRD is the only chronic condition that can get you denied a Medicare Advantage plan. This is one of the features that attract beneficiaries to Advantage plans. However, they don’t consider all the out of pocket costs you have to pay when you go to the doctor. Those with a chronic condition will get better long term benefits with a Medigap plan.

Those with ESRD aren’t eligible for enrollment unless you:

  • Have an Advantage plan at the time of being diagnosed with End-Stage Renal Disease
  • Enrolled in health care coverage through an employer and that specific insurance company also provides Medicare Advantage plans
  • The plan is no longer available. You’re able to do a one-time change and enroll in a different plan in your area
  • Had a successful kidney transplant, thus resolving your ESRD, while still be eligible for a Medicare Advantage plan
  • Find an ESRD Special Needs Plan, which is a type of Medicare Advantage plan

However, there have been some changes to Medicare Advantage plans accepting ESRD patients in 2021.

Switching from Medicare Advantage to a Medigap Plan with Pre-Existing Conditions

Many times, beneficiaries end up wanting to switch from their Medicare Advantage plan to a Medigap plan due to all the out of pocket costs they end up paying when they go to use their benefits. If you have a pre-existing condition that requires you to need regular doctor visits, lab works, tests, etc, then you’ll want to get the coverage that will give you the best benefits upfront.

This is because later when you try to enroll in better coverage, your pre-existing condition can get you denied. When, if you had enrolled when you were first eligible, those pre-existing conditions wouldn’t have impacted your approval odds.

Each carrier has it’s own underwriting questions, our agents are familiar with what each carrier will ask and can guide you in the right direction so that you have the best odds at getting approved with your pre-existing condition.

Can You Be Denied Medicare Coverage?

As long as you enroll during a valid enrollment window, you cannot be denied Medicare coverage.

How to Get Help with Questions on Pre-Existing Conditions

If you have questions about pre-existing medical conditions and how they can impact your coverage, we can help. Our mission is to help you find the best possible health benefits regardless of your current health status. Give us a call, or fill out our online rate comparison form. Our licensed agents are available and ready to help answer all your Medicare coverage questions.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “Does Medicare Cover Pre-Existing Health Conditions

  1. Thank you so much for the great information,i have learned a great deal from reading your facts about the Medicare Advantage plans.I will leave my e-mail address and would like for you to get back with me concerning my transplant over 5 years ago that was 100% awesome.I was blessed to have a perfect match from a 45 year old in perfect health.

    1. Hi Sanford! We would need to speak with you over the phone. Please reach out and give us a call, or complete our rate form to have an agent contact you directly.


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