Are you approaching Medicare and have some pre-existing conditions, and you’re unsure what Medicare will or will not cover?
This is a great question, and we see it a lot here at The Medicare Coach.
In this blog post, I want to go through how the rules work when you have pre-existing conditions so you know which plan you should pick and understand what your options will be in the future to switch plans.
It is not uncommon for people to get confused about this because we hear the Affordable Care Act insurability rules in the news. Here is the thing, the Affordable Care Act rules are very different from Medicare rules and not realizing that can be a real mess later on.
Now, when you first join Medicare, Medicare will cover all of your pre-existing conditions.
At a high level, we have Medicare Part A, which is your hospital insurance. Then there is Medicare Part B, which is your medical insurance. These two parts will cover all of your pre-existing conditions.
Where things tend to get a little tricky are the additional plans to pick from once you have the basic Medicare Part A and B. Since Medicare does not cover 100 percent of your costs, you will choose either a Medicare Advantage Plan or a Medigap Plan (also called a Medicare supplement plan).
Medicare Advantage has very relaxed insurability rules. You can join any of those plans whenever you want, even if you have any pre-existing conditions besides end-stage renal disease.
Now, the trickier situation is if you go on the other side with Original Medicare and a supplement plan (Medigap). Some tricky rules are in place when it comes to pre-existing conditions.
Essentially, these rules say that you can join any Medicare supplement plan within six months of joining Medicare or within six months of living an employer plan that meets Medicare rules.
That means if you have cancer, they have to accept you in that six-month window. But once that window expires, if you try to apply to a plan or switch letters or companies in most states, they will ask you for your health history, and they could deny you coverage for that reason.
What I want you to know is this if you do Medicare correctly and you join Medicare at the beginning with the right plan, they will cover all of your pre-existing conditions. But if you join Medicare wrong and decide that later you would rather be on Original Medicare with a supplement plan versus being on Medicare Advantage, or you want a different supplement company or letter things and get complicated. Essentially, they’re not required to cover you.
At the end of the day, if you do have pre-existing conditions, be careful. Make sure you are doing it right the first time because insurability rules can make it very hard, if not impossible, for you to switch down the road.
