With more people dealing with chronic health issues and the number of older Americans increasing, many on Medicare may be searching for ways to improve their healthcare coverage. This may cause Medicare beneficiaries to consider changing their Medicare Supplement Plan. This article will explore the options available to Medicare beneficiaries with preexisting health conditions who want to switch Medicare Supplement plans.
An aging population means more Americans with chronic health problems, potentially increasing the need for Medicare Supplement plans.
Switching Medicare Supplement plans may mean waiting up to six months for coverage of preexisting health issues.
Enroll in a Medicare Supplement Insurance Plan during the Open Enrollment Period for the best coverage options.
You can switch to Medicare Advantage plans with preexisting conditions.
Over the next several years, the number of people between 60 and 79 with one or more chronic health conditions is expected to increase. According to the Centers for Disease Control and Prevention, by 2060, a quarter of the U.S. population will be 65 or older, a 9% increase from 2019.
This increase could lead to higher enrollment in Medicare Supplement plans as people will need more healthcare coverage for multiple chronic conditions. Understanding the influence of preexisting conditions on your insurance coverage is essential.
Defining a preexisting condition
Preexisting conditions refer to health problems or issues diagnosed six months before your new Medicare Supplement coverage begins. Preexisting health conditions can impact your insurance coverage and the premium cost. Common preexisting health conditions are listed below.
Common preexisting conditions
- Heart Disease
- High Blood Pressure
- High Cholesterol
Preexisting conditions can include many other health conditions, such as obesity and dementia. A preexisting condition doesn’t mean you will be denied Medicare Supplement coverage; however, it can lead to higher insurance premiums.
Understanding Medicare Supplement plans
Medicare Supplement plans, also known as Medigap, provide supplemental coverage to reduce the costs of copayments and deductibles that are not included in Original Medicare coverage. Individuals may enroll in a Medicare Supplement Plan insurance plan to lessen the financial burden of copayments and deductibles.
The best time to enroll in a Medicare Supplement Plan is during your "Medigap Open Enrollment" period. You get a 6-month “Medigap Open Enrollment” period, which starts the first month you have Medicare Part B and you’re 65 or older. During this time, you can enroll in any Medigap policy, and the insurance company can’t deny you coverage due to pre-existing health problems.
Is there a waiting period when changing Medicare Supplement plans?
You may find that your Medicare supplemental plan is no longer sufficient for a variety of reasons.
- Maybe you’ve had a change in your health status, and you want more coverage.
- You could also be seeking a plan with lower insurance premiums.
In this case, you may consider switching to a different Medicare Supplement Plan. However, if you are beyond the "Medigap Open Enrollment" period, there are things you should know about changing Medicare Supplement plans with preexisting conditions.
After the Affordable Care Act was passed in 2010, insurance companies could no longer deny individuals coverage based on preexisting conditions. The Affordable Care Act has helped protect many individuals with preexisting conditions, but it is important to note that the Affordable Care Act protections do not apply to Medicare Supplement plans.
As such, you may face challenges when switching Medicare Supplement plans with a preexisting condition. If you can change plans and have one or more preexisting health conditions, you may have to wait up to six months before your new plan will cover services related to those conditions. Another option for obtaining additional coverage could be to enroll in a Medicare Advantage Plan instead of a Medicare Supplement Plan.
Changing Medicare Advantage plans with preexisting conditions
Enrollment in a Medicare Advantage Plan can be an alternative option to enrolling in a Medicare Supplement Plan. Some benefits of Medicare Advantage may include lower premiums and additional benefits not provided by Original Medicare, such as prescription drug coverage, dental, vision, and wellness programs. You cannot be enrolled in a Medicare Supplement Plan and Medicare Advantage simultaneously. Due to the services covered under Medicare Advantage, you should not need coverage with both.
The Medicare Advantage plans must cover all the services covered by Original Medicare, and you will not be denied coverage based on your preexisting health conditions. It's essential to carefully compare the available Medicare Advantage Plans because they can differ in costs and coverage options.
Changing your Medicare Supplement Plan with preexisting conditions is possible. It's important to know that your preexisting coverage may not begin until up to six months after your new plan starts. Review available plans carefully and evaluate the costs, included services, and coverage to ensure your needs are met. You may also want to consult a licensed insurance agent to help you make the best decision.
What does it mean to have a guaranteed issue right?
Guaranteed issue rights are safeguards that apply to certain situations in which you have the right to get insurance coverage. For instance, if you feel your Medicare Supplement Plan has violated its rules, you can enroll in a new plan regardless of your preexisting health conditions.
Can I switch Medigap plans with preexisting conditions?
Yes. Understanding that any health issues you had before might affect whether you can join certain plans and how much you'll pay for insurance is crucial. This rule doesn’t apply if you change your Medigap plan within the first six months of joining during your "Medigap Open Enrollment" period.
Can you switch Medigap plans without underwriting?
Yes. You may switch Medigap plans without underwriting if you qualify for guaranteed issue rights, or you may change plans during your open enrollment period.
What is the Medicare Annual Enrollment Period (AEP), and when does it occur?
The Medicare Annual Enrollment Period, also called the Open Enrollment Period, happens every year from October 15 to December 7. If you're already on Medicare, this is the time when you can switch to a different Medicare plan that may serve you better.
- Frontiers in Public Health. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model.
- National Center for Chronic Disease Prevention and Health Promotion. Promoting Health for Older Adults.
- Centers for Medicare and Medicaid Services. 2023 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.
- Centers for Medicare and Medicaid Services. Can I change my Medigap policy?
- Journal of the American Board of Family Medicine. Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act.
Show all references
- Health Affairs. Limited Medigap Consumer Protections Are Associated With Higher Reenrollment In Medicare Advantage Plans.
- Centers for Medicare and Medicaid Services. Things to know about Medicare Advantage Plans.
- Centers for Medicare and Medicaid Services. Medicare Open Enrollment.