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Medicare Supplement Plans and Pre-Existing Conditions

Medicare Supplement for pre-existing conditions can begin immediately if you enroll with guaranteed issue rights through a Medigap plan. Otherwise, you can expect to wait six months before coverage of your pre-existing condition begins. Pre-existing conditions include cancer, heart disease, and asthma. According to the Department of Health and Human Services, up to 50% of non-elderly Americans have a pre-existing health condition.

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While pre-existing conditions don’t affect Original Medicare (Medicare Part A and Part B), they can affect Medicare Supplement (Medigap) eligibility. Unlike Original Medicare benefits which come from a program run by the federal government, you’ll receive Medigap benefits from a private insurance carrier, and they can deny beneficiaries coverage under particular circumstances.

Specifically, pre-existing conditions can slow down the process when applying for a Medicare Supplement plan, as you can be denied. Navigating Medigap plans with pre-existing conditions can feel like an uphill battle, but it doesn’t have to be.

Learn more about which conditions affect your eligibility, receiving the right care when switching insurance with a pre-existing condition, the Medicare Supplement waiting period, and more.

Do Medicare Supplement Plans Cover Pre-Existing Conditions?

Yes, Medicare Supplement plans cover pre-existing conditions, but there are several stipulations:

  • For the first six months after you enroll, a Medicare Supplement plan can cover the Part A coinsurance when the visit doesn’t relate to the pre-existing condition.
  • During your Medicare Supplement waiting period, formally known as your pre-existing condition waiting period, a visit relating to a pre-existing condition won’t have coverage.

Although Medicare will pay some of the hospital bills, you pay the rest. This is because Medicare doesn’t have a pre-existing condition waiting period like Medigap. Those with a pre-existing condition enrolling in or changing Medigap plans outside of the Medigap Open Enrollment Period need to budget to ensure they can cover any medical costs for six months.

Medicare Supplement (Medigap) Plans are available through private companies. When applying for a Medigap plan, your pre-existing conditions may be taken into consideration if you don’t sign up during your Medicare Supplement Open Enrollment Period.

If this window has passed for you and you don’t have guaranteed issue rights, you’ll need to answer underwriting health questions when signing up for your policy. In this case, you may need to wait six months for your pre-existing condition to have coverage. Your six-month waiting period begins once your policy starts. Remember, these pre-existing condition waiting periods only apply to Medigap policies.

Medicare Supplement Waiting Period

Federal law doesn’t require insurers to cover pre-existing conditions for the first six months. This six-month waiting period is also known as the “look-back period,” meaning insurers can delay coverage for health conditions that you sought treatment for before applying.

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During this waiting period, Medicare Part A and Medicare Part B continue to provide coverage for pre-existing conditions. Medicare Supplement plans and pre-existing conditions, however, have a different relationship. Once your waiting period ends, your Medigap policy covers costs like deductibles and copays.

It’s important to understand what the waiting period might mean for your healthcare needs. Being ill-prepared can put you in an unfavorable financial position that may have a ripple effect through your budget and even affect the healthcare you receive.

A great way to ensure that you are receiving the benefits you need and are prepared for the costs associated with your healthcare is to speak with a licensed Medicare agent. By doing so, you can review your pre-existing conditions and Medigap insurance options while comparing and planning according to your healthcare and budget needs.

How Do I Avoid the Medicare Supplement Waiting Period?

You can avoid the waiting period by buying your plan during your Medigap Open Enrollment Period. Your Open Enrollment Period gives you a one-time right to enroll in a Medigap plan of your choosing. Enrolling in Medigap during the Open Enrollment Period means that the carrier can’t deny coverage or charge higher premiums.

The good news is that the Medigap pre-existing condition waiting period is often reduced by the number of months that you had creditable coverage before enrolling. Having credible insurance for six months before Medigap could eliminate the waiting period. Thus, those with six months of creditable coverage before Medigap shouldn’t worry about the carrier implementing a waiting period. Employer-sponsored health plans from companies with more than 20 employees are an example of creditable coverage.

If you had six or more months of creditable coverage before enrolling, the Medigap carrier MUST provide coverage immediately. But, if you have more than a 63-day gap, you cannot use creditable coverage to reduce your pre-existing condition waiting period.

Can You Change Medicare Supplement Plans With Pre Existing Conditions?

Yes, switching insurance with a pre-existing condition is possible with Medicare Supplement policies. However, if you’re outside of your Medigap Open Enrollment Period or don’t have guaranteed issue rights at the time, you’ll have to answer underwriting questions and could face denial or increased monthly premiums due to your pre-existing conditions.

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It’s also worth noting that when switching insurance with a pre-existing condition within Medigap plans, you can change your carrier without answering health questions. For example, if you were to switch from Plan A to another Plan A or from Plan B through N to another Plan B through N with the same carrier, you can do so while avoiding medical underwriting.

What Pre-Existing Conditions Are Not Covered by Medicare Supplements?

The list of pre-existing conditions not covered by Medicare Supplement plans is as follows:

Please keep in mind that this list does not include every condition for which someone could be denied during Medicare Supplement underwriting eligibility questions. Some carriers, such as United American are known for being less strict with issuing Medigap policies to people with pre-existing conditions People managing such conditions may find a Special Needs Plan more suitable.

The pre-existing conditions that cause denial for a Medicare Supplement plan vary by carrier. But the fact remains that some individuals won’t qualify for Medigap because of chronic issues.

Medicare Supplement plans and pre-existing conditions can make shopping for coverage difficult, but with a licensed Medicare agent, you’ll be able to compare the plans that you are eligible for, fit your healthcare needs, and still work within your budget.

Do Pre-Existing Conditions Apply to Medicare Supplement Plans?

Yes, a pre-existing condition can apply to Medicare Supplement insurance. While coverage may be available, there are plenty of additional factors listed above, including a waiting period, the potential for denial of coverage, and more.

The key to remember is that private insurance companies are the ones who provide benefits through Medigap plans and maintain a bit of freedom in managing their risk. Therefore, there are situations outside of your Medigap Open Enrollment Period in which you can be denied coverage based on a pre-existing condition.

But options are still available. Because there are so many different companies and 12 lettered Medigap plans, beneficiaries that may be denied coverage with one carrier may also find benefits for their needs with another. Analyze your healthcare options with a licensed Medicare agent to identify and compare your options.

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Do Medicare Supplement Plans Have Pre-Existing Conditions?

No, the Medicare Supplement plans themselves don’t have pre-existing conditions, but rather, beneficiaries may have them depending on their personal health. Each person is different, but as we’ve mentioned above, there are several pre-existing conditions that could make it difficult for you to receive Medigap benefits if you are enrolling outside of your Medicare Supplement Open Enrollment Period.

FAQs

When purchasing Medicare Supplement insurance, can you be asked about pre-existing conditions?
Yes, you can be asked about pre-existing conditions when purchasing Medicare Supplement insurance. If you don’t purchase your Medigap plan during your Open Enrollment Period or do not have guaranteed issue rights during that time, you will have to answer questions about your health and medications when you go through underwriting. These include whether you have pre-existing conditions.
Can Medigap be denied for pre-existing conditions?
Yes, carriers can deny you Medigap plans due to pre-existing conditions. Some carriers will deny people who apply for Medigap policies due to pre-existing conditions if they enroll outside of their Medicare Supplement Open Enrollment Period. Four states are exceptions, however, as Connecticut, Maine, Massachusetts, and New York mandate Medigap providers to provide coverage for eligible beneficiaries.

How to Get Medigap with a Pre-Existing Condition

Medicare Supplement plans help beneficiaries cover the remaining costs of their healthcare leftover by using Original Medicare alone, and whether or not you have a pre-existing condition, enrolling in a Medigap plan during your Open Enrollment Period is the best course of action. Yet, many people enroll in Medigap long after the opportunity passes.

This can cause undue medical expenses and elevated premiums and may even lead to some beneficiaries being denied a Medicare Supplement plan. It’s always important to sign up for Medigap coverage as soon as you are eligible, but if you’ve already missed this opportunity, options are available.

When it comes to Medicare, it doesn’t matter if you’re switching insurance with a pre-existing condition or signing up for coverage for the first time. Our licensed Medicare agents are here to help.

Contact one of our agents at the number above, and they’ll assist you in finding the best plan for your needs. You can also fill out a rate comparison form to compare coverages and see your rates now. We help people like you enroll in Medicare Supplement with pre-existing conditions for better healthcare benefits at the lowest price on the market.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare educator serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.

14 thoughts on "Medicare Supplement Plans and Pre-Existing Conditions"

  1. I have plan N with a Medigap insurer from when I lived in Florida.
    Now I live in Virginia where the plans are much less expensive than in Florida.
    However, I seem to be stuck with the Florida premium.
    What can I do?
    Which insurers would be most lenient in Virginia if I applied to make a change?

    1. Hi Joanne,

      If you are interested in changing carriers, it is importnat to note that each carrier has a different set of heath questions they ask when reviewing your application for coverage. Are there specific diagnoses you are worried about? It may be best to work directly with an agent who can review your health status and recommend a carrier based on the answers you provide. If you would like to do so, you can complete our online rate form to be connected with an agent or even check out quotes from carriers in your area online.

  2. I just got Medicare A&B for being disabled and I was told today that if I buy a Medigap plan because of me being 60 the plan will not cover my pre existing conditions. I live in MS as well pearl river county. Is this true

    1. Hi Pam. If you enroll in a Medigap Plan during your initial enrollment you will receive coverage for pre-existing conditions.

  3. My sister will be Eligible for Medicare in April (65 years old) and currently is insured with an individual healthcare policy. She was just diagnosed with cancer. Will she be eligible for a medigap insurance plan without the six month preexisting illnesses waiting period?

    1. Duane, yes. Your sister will be in her Open Enrollment Period, so no pre-existing health conditions apply, and no waiting periods are necessary.

  4. I currently have Plan F and have had for 6 years in Tennessee. I tried to change to Plan G and was told that in Tennessee my pacemaker/defibrilator were considered a pre-existing condition even though I am well past the 2-year period and I wanted to change within the same company. I was told this restriction was unique within the company to Tennessee. Mutual of Omaha. Last year I was told I could change. This is frustrating and they had no answer. Can you give me any additional information? Thank you.

    1. Hi Nancy – we understand your frustration. Whether you go up or down in Medigap coverage, you’ll need to go through health questions in the underwriting process – regardless of whether you switch companies or not. Depending on the answers to the questions, you could be denied entry into the plan of your choice or face higher premiums if you are accepted.

  5. I began collecting Social Security with Medicare Part A in 2011, and Part B in 2014. I have never had any supplement. Should I get Medicare Advantage or stick with original Medicare? What differences would I find in how each treats preexisting conditions? If I enroll in a Medicare Advantage plan, can I return to original Medicare if I’m not satisfied or can’t afford it?

  6. Hi! My plan F coverage begins on Feb 1,2021. I am scheduled for a cat scan of my abdomen on Jan 22.
    Should a condition be found needing further attention, will my plan F cover this?
    Should I await until after Feb 1 to be diagnosed?
    Laura

    1. Hi Laura! I wouldn’t expect your Plan F to fill in the gaps that Medicare doesn’t pay for the cat scan since it would be before your plan’s effective date. However, it should still cover any additional testing and treatment after the cat scan as long as those services are rendered on or after 2/1. I would contact your agent or carrier directly to confirm.

  7. My husband and I have AARP plan F. We are looking to change to Plan G. I was just told by a Medicare agent that we have to be free of pre-existing conditions for 2 yrs before we can change. I thought open enrollment was the time to change with no questions asked. My husband had a stent put in his carotid artery due to scar tissue from radiation back in 2012. I had a mild stroke in March 2020. The only side effects are some numbness in my left hand and foot. The Plan G premiums are way too expensive. Can you please let me know if it is true that we can’t change.

    1. Hi Kathy! Your agent is correct. The Annual Enrollment Period is for Medicare Advantage and Part D changes. It’s not meant for Medigap enrollees. There’s no annual enrollment window for Medigap plans. There is only a one time Open Enrollment Period that is 6-months long. It begins when your Part B becomes active. After your Medigap Open Enrollment window, you can change plans at any time of the year. You will just have to answer health questions.

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