Does Medicare Cover Pre-Existing Conditions?

Premium Choice

October 31, 2022


If you’re looking for information on Medicare’s Pre-Existing Conditions coverage, you’ve come to the right place. In this article, you’ll learn what Medicare covers and doesn’t cover, as well as Special Needs Plans, which are designed for people with pre-existing conditions.

Medicare covers pre-existing conditions.

If you have pre-existing health conditions, you can take advantage of Medicare coverage without worry. Unlike private insurance, Medicare doesn’t have a pre-existing condition exclusion. As a result, you can have any health condition, including diabetes or cancer, and it won’t affect your coverage under the program. In addition, you can apply for Medicare Part D prescription drug coverage if you have a pre-existing condition.

Medical bills can pile up quickly if you have a chronic condition. Because chronic conditions may require repeated care and expensive treatments, they can be very costly. According to the Centers for Medicare and Medicaid Services, up to 86 percent of older Americans have pre-existing conditions. Fortunately, pre-existing conditions are covered under Medicare and Medicaid, but the pending court case threatens the coverage of millions of people in the United States. However, polls show that many Americans are opposed to eliminating these protections. 75% of the public say keeping pre-existing conditions in place is essential.

Many people are concerned that pre-existing conditions will affect their eligibility for Medicare coverage. They may wonder if they will be denied coverage or wait a waiting period before getting coverage. Medicare Supplement Insurance plans will cover pre-existing conditions as long as they don’t cause hardship for the insurance provider.

Special Needs Plans (SNPs) offer coverage for pre-existing conditions.

Medicare Special Needs Plans (SNPs) are Medicare Advantage plans that offer coverage for people with pre-existing conditions. Most of the cost of these plans is covered by Medicare. But you can qualify for Medicaid benefits as well. The price of these plans may vary, so it is essential to compare programs before committing.

There are three types of SNPs. There are Medicare SNPs, Medicaid SNPs, and Congestive Heart Failure SNPs. Each of these plans offers different benefits and has additional eligibility requirements. As a result, some of them may not be available if you already have Medicaid or Medicare.

C-SNPs cover people with diabetes, lung conditions, and heart disease. A few insurers provide dementia-specific SNPs. Dual-eligible SNPs offer similar coverage to original Medicare. They also provide access to specialists and condition-specific wellness programs.

If you qualify for a Medicare SNP, you can sign up during the regular open enrollment period, which runs from January 1 to March 31. Special enrollment periods also let you sign up immediately or anytime during the year. However, this is not the time to sign up if you already have Medicare.

You can appeal this enrollment decision. You can use your health records and documentation from your provider to prove your case. If you’re denied, your healthcare provider must make a final decision within 72 hours.

Medicare does not cover waiting periods for pre-existing conditions.

A waiting period for a pre-existing condition is when a doctor must evaluate you and prescribe medication or treatment. This period is generally two months, although some people may be exempt from it. Medicare Part A and B provide health insurance coverage for pre-existing conditions without waiting, but some insurers may impose a waiting period for a state. The waiting period for a pre-existing medical condition will be longer if you buy an individual insurance policy.

Before the Affordable Care Act, pre-existing conditions were the common exclusion from health plans. Pre-existing conditions included nearly any health condition before the project was issued. For example, they could have asthma, cancer, heart disease, diabetes, and more. These are chronic health issues that affect large portions of the population. Before the ACA, some health plans would accept new enrollees with pre-existing conditions, but only if the condition was cured or resolved.

In addition to Medicare, private companies also offer Medigap insurance. You may qualify for this type of insurance by meeting specific requirements. During the Open Enrollment Period, you can apply for a Medigap plan. If accepted, you’ll have to answer health questions as part of the underwriting process. Sometimes, you may have to wait six months or more before your pre-existing condition is covered.