How Does Medicare View Pre-Existing Conditions?

Posted by Ron Hows and Susan Kist
Estimated Reading Time 1 minute 13 seconds

Throughout your lifetime, you’ve probably become accustomed to dealing with various health insurance issues. So you might know that pre-existing conditions sometimes complicate health insurance enrollment, and you’re wondering if the same situation can happen with Medicare. The answer is: It depends on the condition, and it depends on your Medicare plan.

Medicare plans that do not deny coverage based on pre-existing conditions…

If you want to enroll in a Medicare Advantage plan, you won’t be denied coverage due to a pre-existing condition. You can enroll or switch between Medicare Advantage plans at the same times you would normally be able to do so.

If you want to enroll in Original Medicare, pre-existing conditions won’t prevent that option. However, if you want to add a Medicare Supplement (Medigap) plan, you could be denied based upon your condition.

Medicare plans that might deny coverage based upon a pre-existing condition…

During your original Medicare enrollment window, you can enroll in Original Medicare plus a Supplement (Medigap) plan, regardless of any pre-existing conditions.

However, if you decide to elect a Medigap plan later, your health is assessed, and you could be denied based upon a medical condition. That’s why it is so important to consider the Medigap option very carefully at the time you turn 65 and enter your original enrollment window. If you turn down the opportunity to enroll in a Medigap plan, you might not be able to do so later.

Working with a licensed agent can help you to understand the differences between plans, and sort through all of the options available to you. This is especially true if you have a pre-existing condition, so don’t hesitate to give us a call if you need help comparing plans.