| Medicare Supplemental Insurance: What to Know About Pre-Existing Conditions

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If you have pre-existing conditions, you may worry about whether or not Medicare Supplement plans will cover bills related to your illness. The following are factors you should take into consideration when approaching healthcare decisions.

PRE-EXISTING CONDITIONS FOR MEDICARE SUPPLEMENTAL INSURANCE

Medicare supplemental insurance closes many of the gaps between what Original Medicare covers and your out-of-pocket costs. If you’re nearing age 65, it’s a good time to research Medigap insurance and decide what level of coverage you might need to protect your health and your finances. 

Does Medicare supplemental insurance cover pre-existing conditions?

If you have pre-existing conditions, you may worry about whether or not Medicare Supplement plans will cover bills related to your illness. The following are factors you should take into consideration when approaching healthcare decisions.

WHAT ARE PRE-EXISTING CONDITIONS?

A pre-existing condition is a condition with which you were diagnosed prior to applying for a health insurance policy. For instance, if you have had Type 1 Diabetes your entire life, you have a pre-existing condition. Similarly, if you were diagnosed with Type 2 diabetes three years ago, you also have a pre-existing condition.

The condition could relate to a genetic disease, injury, or acquired illness.

Insurance companies view people with pre-existing conditions as an increased risk. Since beneficiaries who have already been diagnosed with a condition will need treatment, the insurance company knows it might have to pay more to cover that patient’s healthcare costs.

Pre-existing conditions don’t include short-lived diseases from which beneficiaries recover. For instance, if you’ve ever been diagnosed with strep throat, infectious mononucleosis, or the flu, the insurance company wouldn’t consider it a pre-existing condition.

Since older adults become prone to certain conditions, many people approaching retirement worry about whether they can receive health coverage for those conditions. Fortunately, they almost always can if they follow Medicare’s rules.

APPLY DURING YOUR IEP FOR MEDICARE SUPPLEMENTAL INSURANCE

What you need to know about Medigap insurance and pre-existing conditions 

The Initial Enrollment Period (IEP) starts the first day of the month in which you turn age 65. It lasts for six months, giving you plenty of time to research Medicare supplemental insurance and to figure out which one will best fit your needs.

During your IEP, you can apply for any Medigap insurance plan you want without worrying about your pre-existing conditions. Insurance companies that offer your desired plan in your zip code can’t increase your premium or deny your coverage based on conditions you might already have.

The IEP is different from Original Medicare’s Open Enrollment Period, which occurs once per year from October 15 to December 7. The OEP applies primarily to beneficiaries of Medicare Part C, which is also called Medicare Advantage (MA). If you have a Medicare supplemental insurance plan, you won’t be able to switch without becoming subject to underwriting.

UNDERSTAND THAT A SIX-MONTH WAITING PERIOD MIGHT APPLY FOR MEDIGAP INSURANCE

Some insurance companies institute a six-month waiting period for new beneficiaries of Medicare Supplement plans. During this time, your plan won’t cover costs related to your pre-existing condition. However, once the waiting period elapses, the insurance will begin to pick up those costs. 

The pre-existing condition waiting period doesn’t apply to Original Medicare. You’ll still receive coverage for your condition, but you’ll be responsible for copayments, coinsurance, and deductibles. 

In some cases, the waiting period won’t apply at all. If you have continuous creditable coverage from a different health insurance company during the six months prior to applying for your Medigap insurance, your coverage will begin immediately. Similarly, if you have creditable coverage for a shorter time frame, you can reduce your waiting period by that amount.

For instance, let’s say that you have creditable insurance coverage for the four months prior to applying for Medigap insurance. You would then only have to wait two months for your new Medicare supplemental insurance to cover your pre-existing condition.

KNOW THAT APPLYING OUTSIDE YOUR IEP SUBJECTS YOU TO UNDERWRITING

If you apply for Medicare Supplemental insurance outside your IEP, such as seven months after you turn 65, you become subject to underwriting. Insurance companies use underwriting to determine a beneficiary’s risk.

From the insurance company’s perspective, a beneficiary with a pre-existing condition poses a greater risk than one without because of related costs. Consequently, the company uses underwriting to assess the risk and to adjust premium prices accordingly.

Should underwriting apply, the insurance company can increase your Medigap insurance premium considerably or deny you coverage altogether.

To avoid paying high premiums of eliminating your right to Medicare Supplement plans, mark your IEP dates in your calendar.

UNDERSTAND GUARANTEED ISSUE RIGHTS

Guaranteed issue rights allow you to apply for Medigap insurance outside your IEP without being subject to underwriting. If you have guaranteed issue rights, the insurance company can’t consider your pre-existing conditions.

You still might have a waiting period of six months or less before the Medigap policy covers your pre-existing conditions, but afterward, the Medicare supplemental insurance works just like it does when you apply during your IEP. 

Guaranteed issue rights are Medigap protections that protect your rights in situations that spin out of your control.

You might already know that Medicare supplemental insurance plans are standardized regardless of the insurance company you choose. Each insurance company decides where and if to offer a specific plan, such as Medigap Plan F or Medigap Plan N. Additionally, the individual insurer sets its own premiums.

If your insurance company goes bankrupt or stops offering your plan, you have guaranteed issue rights. You can apply for another Medicare Supplement plan when this happens without becoming subject to underwriting.

The same is true if your insurance company fails to follow Medicare’s rules or if you move out of the insurer’s service area. Also, if you enroll in Original Medicare Part C, you can switch to a Medigap plan during the first 12 months.

CONCLUSION

Pre-existing conditions can prove difficult to navigate when it comes to health insurance. Fortunately, Medicare preserves your rights when you apply for Medicare supplemental insurance during your IEP or when you have guaranteed issue rights.

To find out what Medigap insurance plans are available in your area, use Ensurem’s Medigap Quoter.

Medicare Supplemental Quote

Enter your name, zip code, and other pertinent information, and then select the Medigap Plans in which you’re interested. You’ll get near-instant quotes from the insurance companies operating in your area.

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