Since 65 is the age at which most Americans qualify for Medicare, you may be wondering if you can get affordable health care coverage with preexisting conditions. The short answer is yes. To explain the long answer, we’ll explore how preexisting condition coverage works under Medicare.
Preexisting Conditions Under Original Medicare
Before January 1, 2014, health insurers could charge you more or deny you coverage if you had a preexisting condition like cancer, diabetes, or asthma. However, on that date, the Affordable Care Act (ACA) went into effect, prohibiting these activities. That means your eligibility for Original Medicare (which includes Part A and Part B) is not affected by any preexisting conditions. Likewise, if you need to enroll in Medicare Part D for prescription drugs, you can get coverage regardless of whether you have preexisting conditions, as long as you’re enrolled in Medicare Parts A and/or Part B.
Medicare Advantage and Preexisting Conditions
Also known as Medicare Part C, Medicare Advantage plans offer a way to get Medicare Parts A and B benefits from private insurance companies. In many cases, these plans offer prescription drug coverage and cover expenses Original Medicare doesn’t, such as fees for fitness programs, vision services, dental care, and hearing assessments. You can join a Medicare Advantage Plan whether or not you have a preexisting condition without being charged more, but you are required to be enrolled in Medicare Part A and Part B. Prices vary by provider so it’s a good idea to compare Medicare Advantage providers before you sign up.
Preexisting Condition Coverage With Medigap Plans
Medigap plans, also called Medicare Supplement Insurance, are policies sold by private companies that help pay for costs not covered by Original Medicare, such as deductibles, copays, and coinsurance. However, they aren’t quite as accommodating for people with preexisting conditions. Enrolling in Part B triggers your six-month Medigap open enrollment period. insurers can deny you coverage or charge you more for having preexisting conditions. Further, while Medigap insurance providers can’t delay your Medigap coverage for a preexisting condition, they can delay covering costs associated with the preexisting condition for up to six months.
When To Enroll in Medigap
Wondering when is the best time to enroll in Medigap? Here’s a look at your Medigap enrollment options:
Medigap open enrollment period: This six-month period starts automatically the month you’re enrolled in Part B and are at least 65 years old. During this one-time enrollment period, you can buy any policy sold by a Medigap provider in your state for the same price as someone without preexisting or other health conditions. That said, you may have to wait up to six months for coverage associated with your preexisting conditions.After the Medigap open enrollment period: If you enroll after the six-month open enrollment period, you will be subject to medical underwriting by the Medigap policy provider. As a result, they can deny you coverage or charge you more based on your preexisting conditions. You have a guaranteed issue right: If you have a guaranteed issue right, such as if you move out of the service area for your Medicare Advantage plan, insurance companies can’t refuse your application for a Medigap policy or charge you more for one. And they must cover your preexisting health conditions. These are also referred to as “Medigap Protections.”Before turning 65: If you aren’t yet 65, federal law doesn’t require companies to sell you a Medigap policy. However, some state laws do. If you’re able to buy a Medigap Plan before you turn 65 in your state, it may cost you more than if you wait.
If possible, it’s best to enroll during the six-month Medigap open enrollment period. This allows you to access a wide variety of plans at the lowest prices without having to qualify via an insurer’s medical underwriting process. Additionally, if you have a guaranteed issue right, you’ll also receive a guarantee that your preexisting conditions will be covered right away.
The Bottom Line
With most Americans developing at least one chronic health condition by age 65, it’s helpful that most Medicare options no longer deny coverage or increase prices based on preexisting conditions. You can get the coverage you need from Original Medicare and a Part D prescription drug plan, or from a Medicare Advantage Plan without worrying about your health limiting your coverage. But if you’re in Original Medicare and want a Medigap policy as well, be sure to apply during Medigap open enrollment to guarantee coverage.
