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Pre-Existing Condition Medicare Coverage

A pre-existing condition is a significant health care condition that a person has prior to securing insurance coverage. Some examples may be asthma, heart disease and diabetes. When it comes to Medicare and pre-existing conditions, most people are likely to have coverage. Under the Affordable Care Act, there is no additional cost for pre-existing conditions. They will not impact anyone’s eligibility for Medicare. 

In some situations, you may need to enroll in a Special Needs Program if your pre-existing condition qualifies. These programs typically provide coverage for chronic conditions, such as autoimmune disorders, cardiovascular disorders, liver disease, kidney disease and many others. This may allow you to receive additional services specific to your condition, such as extra days in the hospital. Check the full list of qualifying conditions to find out if this applies to you.

Does Medicare Advantage Cover Pre-Existing Conditions?

Medicare Advantage pre-existing conditions follow the same rules as Original Medicare. That is, these plans cannot charge you more if you have a pre-existing condition. However, when it comes to Medicare Advantage plans, pre-existing conditions may alter the cost of your coverage. Because these are private insurance companies, they can set the coverage premium at various levels, though they cannot deny you coverage.

Do Medicare Supplement Plans Cover Pre-Existing Conditions?

Original Medicare — including Medicare Part A and Medicare Part B — may not cover all of the expenses related to your needs. Medigap coverage, also known as Supplement plans, may help with those gaps in coverage. 

When it comes to Medicare Supplement plans, pre-existing conditions may have some coverage. Typically, these policies have more pre-existing condition limitations, and sometimes having these conditions may limit your access to these policies. It’s important to learn more about Medicare supplement pre-existing conditions by reaching out to your provider with questions.

What Is the Medicare Pre-Existing Waiting Period?

Sometimes, Medigap providers impose a six-month waiting period. During this time, your out-of-pocket expenses related to your pre-existing condition may not be covered. It may also not be covered if it was treated or diagnosed within six months prior to your policy starting. 

If, prior to this, you had six months of continuous health insurance before signing up for Medigap coverage, the insurer cannot impose the waiting period. This is called having creditable coverage. You may also avoid this waiting period if you have guaranteed issue rights. These are state and federal protections that require insurers to sell a policy that covers your pre-existing condition without increasing the price you pay for it.

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