The best time to get a Medicare Supplement plan if you have a pre-existing condition is when you first become eligible for Medicare. Beneficiaries new to Medicare qualify for a Medigap Open Enrollment period. There is no medical underwriting during this time, and pre-existing conditions can’t hinder your ability to get a policy.
Although, it’s important to note that many people qualify for Medigap insurance with prior health conditions. Below we’ll explain everything you need about supplemental Medicare insurance when you have previous medical conditions.
Can I get a Medicare Supplement insurance plan with a pre-existing condition?
It’s possible to qualify for Medigap insurance with a pre-existing condition. A previous health condition could include asthma, heart disease, cancer, and diabetes. Any medical condition requiring treatment before applying for coverage is a pre-existing condition.
It’s best to enroll in Medigap coverage as soon as possible; delaying enrollment can lead to a higher premium. However, if you sign up when you initially qualify, there isn’t a health-based rate increase.
The Medigap plan won’t have a waiting period for beneficiaries with prior creditable coverage. However, if there’s a coverage gap, some insurance carriers require you to cover services relating to your health condition for a short period.
Is there a pre-existing condition waiting period with Medigap
A gap in creditable health coverage can result in you paying for services relating to your condition for six months. After six months, the insurance company covers those services.
During the six-month waiting period, Medicare Part A and Medicare Part B will continue to cover a portion of your services.
Can Medicare Supplement plans deny coverage for pre-existing conditions?
Medigap health insurance plans can deny a person coverage for a pre-existing health condition. Each insurance carrier has a different set of guidelines for application denials. For the most part, chronic issues could disqualify someone from a Medigap insurance policy.
Some carriers are more inclined to approve applications than others. Although, in some cases, a Medicare Advantage Special Needs Plan could be the most beneficial.
Can I switch from Medicare Advantage to Medigap insurance with pre-existing conditions?
You can change from a Part C plan to a Medigap policy during a qualifying enrollment period such as the Annual Enrollment Period, Medicare Advantage Open Enrollment Period, or Special Enrollment Period. The policy change needs to happen during a qualifying enrollment period because you can’t disenroll from a Part C plan at any time.
New to Medicare beneficiaries that enroll in Part C as soon as possible may qualify for a Medicare Advantage “trial right.” The trial right is a Special Enrollment Period allowing you to change from Medicare Advantage to Medigap, and you don’t have to go through underwriting.
Outside the Special Enrollment Period, you’ll likely pay a higher premium for a Medigap health plan.
FAQ’s
How do I qualify for guaranteed issue rights?
Guarantee issue rights, or “Medigap protections,” allow you to sign up for a Medigap policy without concern for underwriting outside the Medigap Open Enrollment Period. Generally, to qualify for guaranteed issue rights, you must be eligible for a Special Enrollment Period.
Can I be denied a Medicare Advantage plan due to a pre-existing condition?
No, Medicare Advantage plans don’t deny coverage for prior health conditions. Even End-Stage Renal Disease (ESRD) beneficiaries are eligible for Medicare Advantage plans. Although, a Special Needs Plan could be more beneficial if that type of policy is available in your service area.
Which states allow Medigap plan changes without medical underwriting?
States allowing Medigap beneficiaries to change plans without medical underwriting include California, Connecticut, New York, Missouri, Oregon, Washington, Nevada, and others. Call us to discuss the underwriting rules in your state.
Can I be denied Original Medicare due to pre-existing conditions?
Medicare is for anyone aged 65 or older. Also, Original Medicare is available to those with specific disabilities or those on Social Security disability for at least 24 months. There are no underwriting questions to qualify for Medicare coverage.
Can I be denied Part D prescription drug coverage due to a pre-existing condition?
No, Part D is available to anyone eligible for Medicare. Although, some medications may only be on some drug plan formularies, or they may have drug restrictions. While some medicines may not apply to your plan deductible, others may.
How to get a Medicare Supplement with a pre-existing condition
Since every insurance company has a different underwriting process, working with a licensed insurance agent is the best way to increase your chances of Medigap approval when you have a health problem.
For help navigating Medicare Supplement enrollment, call us at the phone number above. Or, see your options with our online plan comparison tool.
