Does Medicare cover preexisting conditions?

Medicare Parts A and B do cover preexisting conditions, but some Medigap policies may have restrictions.

Preexisting conditions are chronic medical concerns that a person may have prior to taking out health insurance.

Examples of preexisting conditions include:

• cancer
• congestive heart failure
• diabetes

Although Medicare is a health program for those aged 65 and older, some people may qualify for Medicare at an earlier age if they have a disability or qualifying condition.

Preexisting conditions may affect a person’s ability to get a supplementary Medicare policy (Medigap). This article will cover how preexisting conditions may affect Medicare coverage.

Which Medicare plans cover preexisting conditions?

A person can have several preexisting conditions and still qualify for Medicare coverage.

Whether or not a person has preexisting conditions, premiums will be the same for the following:

• Part A: hospital coverage
  
• Part B: medical coverage, such as doctor’s visits
  
• Part C: Medicare Advantage, where a private insurance company manages a person’s Medicare plan
  
• Part D: prescription drug coverage
  

Even though private insurance companies run Medicare Advantage policies, they are under the same rules as the Affordable Care Act (ACA).

Before the federal government passed the ACA, an insurance company could deny a person with preexisting conditions a policy entirely or charge them a significantly higher premium.

As a result of the ACA, this is no longer the case, and a company offering a Medicare

Advantage plan cannot deny a person coverage based on their preexisting conditions.

Medigap exceptions

Supplemental insurance plans — often known as Medigap plans — are available alongside Medicare. These plans have specific rules when it comes to preexisting conditions.

Medigap policies are optional plans that private insurance companies sell to those with Original Medicare. These standardized plans help pay for out-of-pocket costs associated with Medicare, such as:

• coinsurance
  
• copayments
  
• deductibles
  

Enrollment exceptions
A private insurance company cannot deny a person with preexisting conditions a Medigap plan if the person is in their Medicare Initial Enrollment Period (IEP).

The IEP starts 3 months before a person turns 65 and ends 3 months afterward.

During an IEP, an insurance company must sell a Medigap policy regardless of preexisting conditions. However, when a person is outside of their IEP, the company can deny them a Medigap policy. Alternatively, the individual might be subject to higher costs.

For this reason, a person can usually get the lowest possible cost by applying for a Medigap policy when they first qualify for Medicare.

Specialized Medicare coverage

Some insurance companies offer specialized Medicare Advantage plans for individuals with preexisting conditions.

These plans, which are called Special Needs Plans (SNPs), are for those with chronic conditions. These conditions may include:

• autoimmune disorders
• cancer
• dementia
  
• diabetes
• end stage liver disease
• heart failure
• stroke
  

If a person is eligible for Medicare and has a chronic preexisting condition, they may be able to get an SNP.