Can Medicare Supplement Plans Help with Pre-existing Conditions?
This article was updated on: 09/16/2018
If you have health problems, sometimes known as pre-existing conditions, could it help you to buy a Medicare Supplement plan? Could you even buy a Medicare Supplement plan if you have a pre-existing condition?
As a Medicare beneficiary, you may be able to buy Medicare supplemental insurance (also known as Medigap) even if you have a pre-existing condition. But in most cases, the only time you can buy a Medicare Supplement plan with full federal guarantees and protections called “guaranteed-issue rights” is during a specific time frame, described below.
If you have a pre-existing condition, when’s the best time to buy a Medicare Supplement plan?
You may have some opportunities to get a Medicare Supplement plan even if you have a pre-existing condition, without worrying about having to pay more or having your application rejected because of your health condition. You have guaranteed issue rights to get a Medigap policy during your Medicare Supplement Open Enrollment Period, which starts on the first day of the month you’re at least 65 years old and enrolled in Medicare Part B, and lasts six months. This is generally the best time to apply for a Medicare Supplement plan if you have a pre-existing health condition. During your Medicare Supplement Open Enrollment Period, an insurer cannot:
- Deny you enrollment in a Medicare Supplement plan
- Impose a waiting period before providing coverage, except (in some cases) for coverage of pre-existing medical conditions. In some cases, you might face a six-month waiting period before a Medicare Supplement plan will cover conditions related to your pre-existing condition.
- Charge you a higher premium based on your age, health status, or pre-existing health condition(s).
Pre-existing conditions and Medicare Supplement insurance after the Open Enrollment Period
If you apply for a Medicare Supplement plan outside of a guaranteed-issue situation, the plan can use medical underwriting to decide whether to accept your application. Medical underwriting can determine how much to charge you in monthly premiums for the Medicare Supplement plan, and whether your plan will have any coverage restrictions. When performing medical underwriting, the insurer may consider your age, gender, and/or any pre-existing medical conditions you have been diagnosed with or treated for during the six months preceding the proposed start date of your coverage. The company can turn down your application if guaranteed-issue rights don’t apply.
Can you avoid or reduce a plan’s pre-existing condition waiting period?
Medicare Supplement insurers may be able to refuse to cover your pre-existing medical conditions for up to six months. This is the Medicare Supplement “pre-existing conditions waiting period.” This applies to any health conditions you were diagnosed with or treated for within six months of the Medicare Supplement plan coverage start date.
You may be able to avoid or reduce the pre-existing condition waiting period if you have had creditable health coverage. Many forms of health coverage count as creditable as long as there is no break in coverage for more than 63 days. Usually, your Medicare Supplement plan’s pre-existing waiting period is reduced by the number of months you had creditable coverage prior to enrolling in the Medicare Supplement plan, up to six months.
Pre-existing conditions and changing Medicare Supplement plans
If you are switching from one Medicare Supplement plan to another, keep your current coverage until your new Medicare Supplement plan confirms that your coverage is in effect. When you are changing Medicare Supplement plans during your Medicare Supplement Open Enrollment Period, the Medicare Supplement plan cannot typically reject your application because of pre-existing medical conditions, or impose a waiting period for coverage (if you had your old plan for at least six months). However, the new plan may impose a waiting period of up to six months related to any specific benefits that weren’t covered under your old plan.
I am here to help you if you would like to learn more about Medicare coverage when you have a pre-existing condition. Feel free to contact me.
- We can set up a phone call if you follow one of the links below, or you can have me email you some information about Medicare plan options.
- If you’d like to research your Medicare coverage options on your own, just click on the Compare Plans or Find Plans buttons on this page.
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.