Will Medicare Cover You If You Have A Pre-existing Condition?

Medicare defines a pre-existing condition as any health or condition or disability that you have before the coverage start date for a new insurance plan. In most cases, yes, your Original Medicare or Medicare Advantage plan will cover you, even with a pre-existing condition. The exception is being enrolled in a Medigap plan

Medicare Supplement Plan Coverage

Medicare Supplement plans are also referred to as Medigap. Private insurance companies offer these plans, which provide coverage for out-of-pocket costs that aren’t covered by Medicare Part A and Part B. Medicare Supplement plans, or Medigap, help fill in the gaps of coverage where Medicare Part A and Part B may not pay. 

If you do not take advantage of enrollment during the Medigap Open Enrollment Period, then the private insurance companies who offer these plans have the option of denying coverage due to your pre-existing condition or will make you undergo medical underwriting to determine your eligibility. Even if your Medigap application is accepted, your private insurance company may not cover your pre-existing condition for another six months, also known as the “look-back period,” or the “pre-existing waiting period.” 

If you enroll during your personal Medigap Open Enrollment Period, then you cannot be denied coverage or receive a higher premium. You will have what is known as a guaranteed issue right to enroll in a Medigap plan. This open enrollment period begins when your Part B coverage starts and continues for six months after that date.

Original Medicare And Medicare Advantage Plans

Original Medicare plans and Medicare Advantage plans will provide you with coverage, even if you suffer from a disability or pre-existing condition. You will not receive higher premiums because of your pre-existing condition. You will still receive coverage from Medicare Part A (hospital coverage), Part B (physician and preventative services), and Part D (prescription drug coverage). 

You may even qualify for a Medicare Advantage Special Needs Plan, such as the Chronic Condition Special Needs Plan (C-SNP). C-SNPs are available to those with certain chronic conditions and needs.

To learn more about your Medicare coverage options, reach out to Carolina Senior Benefits today.