Enrolling in Medicare can seem like a daunting task that is full of uncertainty. With changing regulations and enrollment guidelines and conflicting reports on the news, it can be difficult navigating the process of receiving coverage.
You cannot be denied Original Medicare coverage because of pre-existing conditions.
It is important to identify your Medicare initial enrollment period and apply for coverage within that window.
Medicare will cover your pre-existing conditions to the extent of what the plan allows.
You are eligible to apply for Medigap through private insurers as long as you are also carrying Medicare Part A and Part B.
As with Medicare, you cannot be denied coverage from Medigap because of pre-existing conditions.
Pre-existing conditions offer an additional layer of complexity. If you’ve had an injury or contracted an illness before turning 65, you may wonder how it may affect your eligibility and what options are available to you.
To help, we’ve compiled this guide of the most important information that you should know when trying to enroll in Medicare with pre-existing conditions in 2023. Let’s get started.
What are pre-existing conditions?
According to HealthCare.gov, a pre-existing condition is any health problem like asthma, diabetes, or cancer that you had before the scheduled start date or application for your Medicare healthcare coverage. Additional examples of pre-existing conditions include:
Will Medicare eligibility be affected because of a pre-existing condition?
Also known as previous health conditions, pre-existing conditions do not negatively affect your Medicare eligibility or plan options. Medicare is not dependent on the status of your health so any existing health conditions will not affect your eligibility as long as you apply at the correct time. This applies to Medicare Part A, Part B, or Part D.
The bottom line, you cannot be denied Medicare coverage for pre-existing conditions as long as you follow the correct procedures and adhere to proper enrollment windows. Let’s look at what those are.
How do I enroll in Medicare with pre-existing conditions?
If you have pre-existing conditions, you will need to submit your enrollment at a time when health questions are not required. This is referred to as the Initial Enrollment Period. It’s important to be clear on this since it only happens once in a person’s lifetime or under special circumstances. It is different for each person, it’s why many people end up missing out.
Understanding the Initial Enrollment Period
A Medicare Initial Enrollment Period is a window that lets newly eligible recipients enroll for Medicare coverage. It differs from person to person and is based on several factors. Generally, it is when you turn 65 years old.
Your enrollment period lasts for seven months, starting three months before you turn 65 and ending three months after the month you turn 65.
If you miss this Initial Enrollment Period, you can still enroll between January and March of each year but you might pay a monthly late enrollment penalty if you don’t qualify for an additional special enrollment period.
Of course, there are special situations that may impede your enrollment. In cases like this, it's best to refer to the Medicare website to receive clarity on your unique situation and how that would affect your enrollment period. You may also qualify for automatic enrollment into Medicare if you are already collecting Social Security benefits before your 65th birthday.
As a federal program and under current legislation you can enroll with no health questions. If you have pre-existing conditions, knowing your correct enrollment periods will save you additional expenses and headaches.
Does Medicare cover my pre-existing conditions?
The extent of your Medicare coverage is not affected by when you contracted a condition. Conditions that were present before the start date of your Medicare coverage will still be treated within the parameters of your plan.
It’s important to keep in mind that while it covers your pre-existing conditions if it falls out of the parameters of your Medicare coverage, you will still be responsible to carry that additional expenses on your own. This is where Medigap or Medicare supplement health insurance comes into play.
What is Medigap insurance?
A Medigap policy is health insurance that fills the “gaps” in Original Medicare Plan coverage. They help pay a portion of the health care costs that the Original Medicare Plan does not cover.
If you are in the Original Medicare Plan and have a Medigap policy, both policies will each pay their share of covered healthcare costs. You will need to carry a Medicare Part A and Part B policy and pay the monthly premiums associated with Medicare Part B. Since it’s provided by a private insurance company, there is a premium involved with Medigap as well.
Can I enroll in Medigap with pre-existing conditions?
As is the case with Medicare, federal law prohibits private insurers from denying Medigap coverage to individuals with pre-existing conditions. However, as with Medicare, when you enroll will play a factor. You will want to note the enrollment period that does not require health questions related to pre-existing conditions.
Enrolling in Medicare with pre-existing conditions is possible. Regardless of your physical health at the time of enrollment, you cannot be denied Medicare coverage as long as you follow the steps outlined above.
While the entire process can seem overwhelming at first, as long as you know when your Medicare initial enrollment period begins and apply during that time and do the same with your Medigap policy, you will receive the same comprehensive Medicare and Medigap coverage as everyone else.