How Pre-Existing Conditions Affect Medicare Eligibility
September 5, 2019
If you have a pre-existing condition, you’re not alone. According to the Centers for Medicare & Medicaid Services (CMS), up to 86% of people between 55 and 64 have a pre-existing condition, which may include cancer, heart disease, diabetes, or asthma.
While pre-existing conditions do not impact eligibility for Medicare Parts A or B, they can affect your enrollment in Medicare supplement insurance plans. It’s important to keep the following points in mind while navigating the enrollment process.
Don’t Miss Open Enrollment
The Medicare Supplement Open Enrollment Period begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. During this period (which occurs only this once in your lifetime), you are exempt from being denied a policy because of any pre-existing conditions. In addition, during this period, an insurance company is not permitted to charge you more than they would a person without pre-existing conditions. This time is ideal for enrolling in a supplement plan, as you will not be subject to any medical underwriting. Your coverage, without any increased premiums, is guaranteed.
But If You Do
If you miss your open enrollment period, you can still apply for a Medicare supplement insurance plan, but the process will be a little more complicated. You will most likely have to go through medical underwriting, which may result in a carrier turning down your application because of an underlying health issue.
A rejected application does not deny you coverage permanently, but may subject you to a “pre-existing condition waiting period” of six months. During this time, you may be required to pay all of your own out-of-pocket costs for care related to your pre-existing condition. After the waiting period, the Medicare supplement insurance plan will start covering those costs.
Changing Plans
If you wish to change from one Medicare supplement insurance plan to another, you will most likely have to answer health questions that may result in a denial of coverage. Applying for a new supplement, however, does not cause you to automatically lose your current coverage. Just keep in mind that you should not actively cancel your current plan until you have been approved for a new one. And remember, before you cancel your current coverage you should confirm that you will receive the benefits you need in the new plan.
Would you like some assistance in navigating the Medicare enrollment process? Classic Insurance & Financial Services is an independent brokerage that specializes in helping clients select the right type of Medicare health insurance for their specific needs. To seek out our resources, services, and advice, click here or subscribe now to receive quarterly updates and guidance about navigating retirement and Medicare enrollment.
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