As Medicare insurance agents in Springfield, MO, we often get questions regarding pre-existing conditions and Medicare coverage. People often ask:
“Can I get Medicare with health problems?”
The answer to this is yes.
“Can Medicare deny you for pre-existing conditions?”
Thankfully, this is a no.
“Does Medicare have pre-existing condition coverage?”
This is a yes!
“I have health problems, can you find a plan for me?”
Of course; let’s schedule a meeting and we’ll pick the right plan for your situation.
The great news for Medicare enrollees is that Medicare will enroll anyone otherwise eligible into Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage), even with a pre-existing condition.
Your Medicare Initial Enrollment Period allows you to sign up for most plans without answering any health related questions. If you’re interested in Medigap (also known as Medicare Supplement Insurance), you should also do that when you first enroll (read more about that below).
Your Options: Medicare Advantage v. Medigap
Since Medicare Parts A, B, and D leave extra costs for you to cover out-of-pocket, you may be interested in a plan that has more extensive coverage. This is especially true if you have a pre-existing condition.
Two options to help you cover expenses related to your pre-existing condition are Medicare Advantage and Medigap (a Supplemental plan, also called Plan F). Plan F is not available to new enrollees.
Medicare Advantage plans are generally chosen by people who are looking for a low or no monthly premium. Of course, this comes with having to use a network, higher copays and coinsurance.
Medigap plans can be a good option for those with pre-existing conditions because the premiums are higher, but your out-of-pocket expenses when you do get treated are lower.
Medigap (Medicare Supplement Insurance) and Pre-Existing Conditions
Medigap, or Medicare Supplement Insurance, is popular among people with health issues or pre-existing conditions because you won’t be paying out of pocket for every doctor’s visit or lab test once you reach your yearly deductible ($198 for year 2020). You can plan your expenses every month.
There are several different enrollment periods for Medicare, like the Initial Enrollment Period, General Enrollment Period, and Special Enrollment Periods. In addition, Medigap has its own Open Enrollment Period which starts the month you turn 65 and enroll in Part B. (If you have insurance through a third party, your Medigap Open Enrollment Period will start when you enroll in Part B.) It lasts 6 months. You’ll be able to purchase a Medigap (Medicare Supplement insurance) plan for the same rate as someone with no health problems.
If you wait to purchase a Medigap plan, insurance companies may be able to deny you coverage or charge based on your health issues.
Trial Rights and Guaranteed Issue Rights
Medicare lays out a variety of situations (called Guaranteed Issue Rights) when you can still purchase Medigap without being charged extra or denied for your health situation. Many of them deal with losing coverage or moving.
Trial Rights allow you to try out Advantage or Medigap plans and change if you’re not satisfied. Both Trial Rights and Guaranteed Issue Rights come with many stipulations, so it’s best to work with an experienced agent.
If you’re interested in Medigap, but aren’t sure of the costs or your eligibility, we’re happy to walk you through your options.
Medigap Pre-Existing Condition Waiting Period
So you signed up during the Medicare Supplement Insurance (Medigap) Open Enrollment Period when you turned 65- great! Your plan generally can’t make you wait to enjoy your benefits. Your Medigap plan can start immediately paying its portion of your out-of-pocket costs for your pre-existing condition.
However, if you did sign up after your Medigap Open Enrollment Period, you may be subject to a waiting period of 6 months for payouts for treatments involving your pre-existing condition. If you have arthritis and go to the doctor for the flu during your waiting period, Medigap will pay its portion of coinsurance toward that visit. If you see your doctor for a visit concerning (pre-existing) arthritis pain, Medigap probably won’t pay until the 6 month waiting period is over.
Our main point here is that if you want Medigap (Medicare Supplement Insurance) it’s best to get it when you first enroll in Medicare.
We understand- navigating Medicare, Medicare Advantage plans, and Medigap can be tricky with a pre-existing condition. Just know that we’re here, we understand the process and the dates for signing up, and we do not charge you anything to get help choosing a plan.
We’ve helped hundreds of Medicare enrollees in Southwest Missouri and we’d love to help you too!