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.

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.

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.

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:

• ALS (Lou Gehrig’s Disease)
• Asthma
• Cancer
• Chronic obstructive pulmonary disease (COPD)
• Diabetes
• End-Stage Renal Disease (ESRD)
• Stroke

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.

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

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.

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