Can I get Medicare insurance with pre-existing health conditions?
Can you get Medicare insurance with a medical history, or if you currently have an ongoing health problem, for example with diabetes, cancer, or heart disease? The good news is, yes, you can, but you have to follow Medicare’s guidelines, which means you need to apply at the right time for the right plan.
Most persons in the United States are eligible for Medicare when they turn 65. While original Medicare provides basic health care coverage, it won’t pay all expenses in regards to medical services. In addition to that, Medicare doesn’t cover insurance coverage for many health related services such as prescription drugs, vision, or dental. Especially for persons with pre-existing health conditions, this means that they may face devastating out of pocket expenses for their medical bills, if they don’t add additional coverage to their traditional Medicare plan.
Will Medicare Supplement Insurance Accept Me With A Pre-Existing Health Condition?
Supplemental insurance is offered by private insurance companies that are approved by Medicare, and offered as 10 standardized Medigap plans. Each plan has specific benefits, and not all Medigap policies may be offered in your state. If you have one or more Medigap plans available to you (you may check the plan finder at MyMedicare.gov to find out), you will be able to purchase the plan regardless of any health issues you may have ONLY at the time when you are first eligible for Medicare. Generally, persons over age 65 who are receiving Social Security automatically qualify for Medicare Parts A and B. You must enroll in Part A (hospital insurance) and Part B (medical insurance) during a specific time frame, called the ‘initial enrollment’ period, which typically lasts 6 months before to 6 months after your 65th birthday. As soon as you are enrolled in Part B, you also qualify for Medicare supplemental insurance, in spite of pre-existing medical conditions. Once you have purchased supplemental insurance, the insurer cannot cancel your coverage, as long as you stick to the regulations and pay your monthly premium.
If you however miss the initial enrollment period, you won’t have a guaranteed right to enroll in a supplemental policy anymore. Insurance companies may still sell you a Medigap policy at a later point in time, but they are now allowed to use ‘medical underwriting’, which means you will most likely have to undergo a health check, and the insurer can deny you coverage because of pre-existing conditions, or accept you only at a higher premium.
If you have a pre-existing condition, you also need to be careful when switching Medigap policies: Don’t cancel your current one before you have a written confirmation that the new policy will accept you. You won’t have the right to go back into a previous plan after you have canceled it.
Under specific circumstances you are however protected and are able to switch policies without underwriting, for example if you move to another state, where your Medigap policy is not offered. For details, see Medicare.gov.
Can I Enroll In A Medicare Advantage Plan With A Pre-Existing Health Condition?
The top selling point of Medicare advantage plans is affordable premiums along with expanded benefits. Plus, there’s another reason for you to select a Medicare advantage plan, if you have a pre-existing condition: Medicare advantage plans have guaranteed acceptance for all persons with past or current health problems. Because the premiums for advantage plan policies are driven competition between private insurance carriers, you can often find a zero premium or low-cost policy that will cover all or most of your health requirements.
Like supplemental insurance, you are able to enroll in a Medicare advantage plan first when you become eligible for Medicare. Unlike Medigap however, you are still able to enroll after you missed the initial enrollment: each year during the ‘Open Enrollment’ period in fall, between October 15th and December 7th, you may enroll in a Medicare advantage plan, or switch your current plan. Because of the guaranteed acceptance, you won’t have to go through any health check or underwriting if you decide to enroll at a later date.
Medicare advantage plans are subsidized by the government, which means that the government pays insurance companies a flat fee to provide your health services regardless of the actual costs of your healthcare. This helps insurance carriers being able to provide better coverage than Medicare at a reasonable premium, which is typically lower than what you would pay for a supplemental plan. However, it also means that the government or the insurer are free to discontinue a plan at the end of each year.
As long as you pay attention to those dates, you should not have problems enrolling in a Medicare supplement or advantage plan, even with pre-existing conditions.
