Does Medicare Cover Pre-Existing Conditions?

Tamera Jackson by Tamera Jackson | Licensed since 2007
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This article was updated on: 09/10/2018

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In general, Medicare covers pre-existing conditions. You won’t be denied coverage by Original Medicare, Part A and Part B, the federal health-care program. In fact, in some cases, you may be eligible for Medicare before you turn 65 due to health conditions.

You’re typically eligible for Medicare when you turn 65 if you’re a United States citizen or a legal resident for at least five years in a row. If you have a health condition or disability, you might qualify for Medicare before the age of 65 if any of the following applies to you:

  • You receive disability benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB). If you’ve been receiving these benefits for 24 months in a row, you’ll be automatically enrolled in Medicare during the 25th month.
  • You have amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease). Your Medicare benefits may start during the first month you receive SSA or RRB benefits.
  • You have end-stage renal disease (ESRD) – that is, you have kidney failure that requires you to receive dialysis regularly, or a kidney transplant. In this case, you might qualify for Medicare, but you will usually need to apply for Medicare instead of getting enrolled automatically, if you’re under 65 years old.

However, there are a couple of situations you may want to be aware of if you’re concerned about Medicare coverage of pre-existing conditions.

  • If you have end-stage renal disease (ESRD), you might not be eligible for a Medicare Advantage plan. Medicare Advantage plans are available from private insurance companies that contract with Medicare. These plans provide your Medicare Part A and Part B benefits (besides hospice care, which is still covered directly through Medicare Part A). If you have ESRD and you want to apply for a Medicare Advantage plan, contact the plan to see if you’re eligible.
  • If you’re interested in buying Medicare Supplement insurance and you have a pre-existing condition, in some situations you might not get accepted. If you apply for the policy after your Medicare Supplement Open Enrollment Period is over, the private insurance company selling the plan can require you to have a health evaluation. If you have a health condition, the company can deny you coverage, charge you a higher premium, and/or impose a waiting period before coverage begins.

Here are a couple of useful tips about Medicare Supplement insurance:

  • In some states, you need to be age 65 or over to be eligible for Medicare Supplement insurance, even if you qualify for Medicare before age 65.
  • So, if you’re new to Medicare or planning ahead for Medicare, and you’re thinking about buying a Medicare Supplement plan, it may be worth your while to buy a plan during the Medicare Supplement Open Enrollment Period. This six-month period generally begins the month you’re both 65 or older and enrolled in Medicare Part B. During this period, no Medicare Supplement plan can reject your application because of a pre-existing condition (but you might face a waiting period before coverage related to that condition begins).

Are you worried about getting adequate Medicare coverage for your health needs? I’m here to help. To set up a phone call with me, or request more information by email, you can click on the links below this article. Want to explore some Medicare plan options on your own? Just click the Find Plans or Compare Plans button.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

The purpose of this communication is the solicitation of insurance.  Contact will be made by an insurance agent/producer or insurance company.

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the Federal Medicare program.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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