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Help, I have a pre-existing condition. What do I do?
Have you suffered an illness or injury before becoming eligible for Medicare?
You may be wondering if this affects your eligibility or potential coverage options. This can be a scary topic if you do not understand your rights. Let’s chat about how Medicare works with pre-existing conditions.
Medicare considers pre-existing conditions as any health issue prior to the coverage start date.
Having a pre-existing condition simply means having a sickness before coverage begins.
As we already know the best time begin your Medicare is when you first become eligible. The golden age of 65 is a marvelous time as no one can deny you coverage at any time. No matter your past, present, or future health situations you are allowed to freely choose coverage. This is a key component especially if you have a pre-existing condition! You cannot be denied if you begin coverage when you are first eligible granting you the ability to buy no- matter- what. This is essential information as if you can avoid getting turned down or postponing any treatment, this is the time; to go for it and enroll at the right time.
Medicare Advantage will cover pre-existing conditions. This does not affect enrollment. However, there are certain times for enrollment.
If you do not have a “guaranteed issue right”, then you will have to answer a health questionnaire and there is a possibility of rejection or charge you more based on your medical condition. The rules on coverage can vary based on medical conditions and timeframe can affect coverage and may vary from state and insurer.
Will Medigap cover pre-existing conditions?
Rules are different for Medigap coverage (a plan that many purchase to assist in Medicare’s deductibles and copayments). At the golden age of 65 & older federal law grants you access to buy with full protections also known as “guaranteed issue rights”. For a six months period post enrollment of part B a person cannot be denied a Medigap policy or be charged higher premiums based on current medical conditions or health. However, some people may also qualify beyond this time frame.
If you purchase a Medigap policy during your 6-Month Medigap Open Enrollment Time, you may be able to avoid or reduce your waiting period for pre-existing conditions. A pre-existing condition waiting time cannot be applied by the insurance company if you purchase a Medigap policy while having a guaranteed issue right.
Keep in mind if you are younger than 65 and have been rejected, the clock will reset at 65 based off your age, not your disability.
None of us can predict what the future will bring, but we do know what is available right now, part of which is pre-existing condition coverage that is legally guaranteed.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area.
Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.