While Medicare benefits can ease the burden of your health care expenses, you are still left responsible for deductibles, copayments, and coinsurance. Many people will get supplemental insurance to help cover these expenses. Understand how your pre-existing conditions can affect your coverage options to avoid any unexpected costs.

Pre-Existing Conditions & Medicare Benefits

As of 2021, End Stage Renal Disease is not considered a pre-existing condition that will prevent a Medicare beneficiary from enrolling in an Advantage plan.  While Original Medicare will not deny coverage because of pre-existing conditions, there are some exceptions when enrolling in a Medicare Supplement plan (Medigap) outside your Guaranteed Issue period.  

Underwriting guidelines tend to vary by insurance company, so what is acceptable for one insurer may not be for another. Also, pre-existing conditions might not be covered for up to the first three to six months after you receive your membership. This is called the “pre-existing condition waiting period.” If you have six months of creditable coverage prior to enrolling in the Medigap plan, you may be able to avoid the waiting period. 

Bridging the Gap

There are special conditions for enrollment (Guaranteed Issue) in Medicare Supplement (Medigap) plans that take pre-existing conditions out of consideration. For individuals that try to enroll without a Guaranteed Issue period and have pre-existing conditions that keep them from qualifying for a Medigap plan, one of the best options might be a Medicare Special Needs Plan which is a special type of Advantage plan. These plans are specifically tailored for individuals with a chronic condition such as chronic heart failure or diabetes. These specialized plans may be better suited for your health situation. There are also some offered through institutional settings such as nursing homes.

I you are most interested in a Medicare Supplement plan (Medigap) It may be worth shopping different Medigap plan insurers. One insurer may still be willing to provide coverage to you with your pre-existing condition, even if another does not. Also, you could be accepted with your pre-existing condition at a higher rate premium.  Thoroughly evaluating your options will ensure you have adequate coverage to address your health care needs.  Remember that Advantage plans do not require underwriting or take into account any pre-existing conditions for acceptance.

If you need help understanding Medicare benefits and your health insurance options, contact The Clemente Agency in Gilbert, AZ. Licensed insurance broker Sharon Clemente brings over 14 years of industry experience to help you get the coverage you need and will help you fully understand available plans. To learn more about plans and rates, visit them online or call (480) 209-2250.