If you’re approaching your 65th birthday and have a pre-existing condition, you may be asking yourself: will I be able to sign up for Medicare? Let’s go over what you need to know about pre-existing conditions and your Medicare coverage.

Medicare and Pre-Existing Conditions

When it comes to Medicare, there are no pre-existing limitations under Part A, Part B, Part C, or Part D. Under provisions of the Affordable Care Act, Medicare provides coverage for any medical expenses related to pre-existing conditions developed prior to your initial enrollment period. So whether you are completely healthy or have been diagnosed with a chronic condition, when you become eligible for Medicare, you don’t have to be concerned about being accepted.

All chronic illnesses and pre-existing conditions are covered, so if you have diabetes, ALS, cancer, epilepsy, or an autoimmune disease, you can rest assured you will qualify for Medicare. If you feel like Medicare has denied you coverage based on a pre-existing condition, you can file an appeal or reconsideration.

Will I Pay Extra for Coverage?

There’s no paying extra due to your pre-existing condition. Due to changes made through the Affordable Care Act, there will be no additional cost for Medicare coverage if you have pre-existing conditions. Premiums for Part A will be in the same general range, and the standard premium for Part B will remain the same regardless of your health conditions.

Do Medicare Supplement Plans Cover Pre-Existing Conditions?

Medicare Supplement plans, also known as Medigap policies, help to cover the costs that Original Medicare doesn’t. With original Medicare, you pay deductibles, copays, and 20% of services you receive from your doctors, but a Medicare Supplement plan can “fill in the gaps” and pay for some or all of these costs for you.

So do Medicare Supplement plans cover pre-existing conditions? Yes – as long as you enroll at the right time. When you’re turning 65 or on your Medicare Part B effective date, you’re offered an open enrollment period of six months. During this time, you’re granted Guaranteed Issue Rights. This means private insurance companies offering Medigap plans cannot deny you coverage or increase your rates due to any pre-existing health conditions.

If you don’t enroll during your open enrollment period, you can be denied coverage or charged a higher premium due to pre-existing health conditions. The insurer may also make you wait up to six months before covering your pre-existing condition. This is known as the Medigap “pre-existing waiting period” and applies to any health conditions you were diagnosed or treated for within six months of the Medicare Supplement plan coverage start date.

In short, if you have a chronic or pre-existing condition and you want to enroll in a Medicare Supplement plan, you should do it during your open enrollment period.

Medicare Special Needs Plans

While we’re discussing pre-existing conditions, you may be able to enroll in a Medicare Special Needs Plan (SNP) if you have a qualifying pre-existing condition. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best help those with specialized needs.

There are a few ways to be eligible for a Medicare SNP, but one way is if you’re an individual with a specific chronic or disabling condition. You may be eligible to enroll if you have one or more of the following:

  • Autoimmune disorder
  • Cancer (excluding pre-cancer conditions)
  • Cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Neurological disorders
  • Chronic and disabling mental health conditions
  • Chronic lung disorders
  • End-stage liver disease
  • End-stage renal disease
  • Diabetes mellitus
  • Stroke

If you are eligible, you can enroll in a Medicare SNP at any time if a plan is available where you live. Otherwise, you can still get Medicare coverage through Original Medicare or Medicare Advantage Plan.

How to Choose the Best Medicare Plan for Pre-Existing Conditions

The best Medicare plan for pre-existing conditions is a relative term because all Medicare beneficiaries have different needs. Your best option could be an Original Medicare and a Supplement plan, a Medicare Advantage plan, or Medicare SNP, depending on your specific healthcare needs.

It can be hard to figure out what plan you need, especially with the confusing maze that is Medicare. If you’re looking for assistance, a Medicare insurance agency like Jeffery Insurance can help you choose a Medicare plan that best suits your needs. Our team is here to help you understand Medicare and answer any questions you have about coverage. We are based in Scottsdale but are happy to assist you no matter where you are in Arizona. We are Arizona’s health care resource!