Medicare Coverage and Pre-Existing Conditions: What You Need to Know

Once you reach the age of Medicare eligibility (65), you will face several choices regarding your Medicare enrollment. If you’re feeling overwhelmed by all of the options available on the market, it can help to remind yourself that you can always change plans next year. But is that true in every situation? And can pre-existing conditions prevent you from switching plans later?

Yes, in some cases a pre-existing condition can complicate your situation, with regard to your Medicare enrollment options. Let’s review how the different types of plans treat pre-existing conditions, and under which circumstances you could be denied coverage.

Medicare Advantage plans. Medicare Advantage plans do not impose restrictions upon those with pre-existing conditions, so you can enroll regardless of a prior diagnosis except for end-stage renal disease. During times that you can otherwise change plans, you can drop Original Medicare and enroll in Medicare Advantage, or switch from one Advantage plan to another, regardless of all other pre-existing conditions.

Original Medicare. Original Medicare also will not deny you coverage based on a pre-existing condition. However, the situation becomes more complicated if you’d prefer to enroll in Original Medicare plus a Medicare Supplement (Medigap) plan.

Medicare Supplement (Medigap) plans. These plans can and do deny applicants based on their pre-existing conditions. During your initial enrollment window for Medicare at age 65, you can enroll in Original Medicare plus a Medigap plan even if you have a pre-existing condition. However, if you decline the opportunity to elect a Medigap plan and then change your mind later, it is possible to be denied at that time.

So, if you already have a pre-existing condition when you turn 65, consider your Medigap options carefully. You might not be able to opt into these plans later, if you initially declined them.

Working with a qualified broker can be the best way to assess and anticipate your healthcare needs both now and in the future. Plus, this professional can help you to understand complicated Medicare rules, and prevent situations of regret later on. Give us a call to discuss your Medicare enrollment options in light of a pre-existing condition, and we can help you identify the plans available to suit your needs and budget.