Medicare Supplemental Plans & Pre-existing Health Conditions

Over the years, there is one concern about medical coverage that typically is on everyone’s mind. Pre-existing conditions. When applying for medical insurance coverage, we tend to worry about our pre-existing health conditions, the extra cost of those conditions, and at times if you are, approved for health coverage.

What is a pre-existing condition?

Basically, a pre-existing health condition that you had previously, or before your new health coverage took effect. It is not uncommon to have a pre-existing condition, no matter what age you are. Any injury or illness such as heart disease, diabetes, arthritis, or cancer is included as a pre-existing condition if you were diagnosed and treated for it before your current health coverage took effect.

Who determines a pre-existing condition?

When you sign up for health coverage, typically your application will go through an underwriting process. During the underwriting process, insurers determine pre-existing health conditions based off of your health history. Based on your health history insurers are also able to decide what the rates of the plan will be.

There is a specific period that Medicare supplement plans cannot use medical underwriting during the application process. This period is the Medicare Supplement Open Enrollment Period. This six-month period of open enrollment, insurance companies cannot legally refuse or disqualify you for an insurance policy based off of pre-existing conditions, nor can they charge a higher premium than what someone without health issues would pay. The best time to enroll in medical coverage is during the open enrollment to minimize the chance of denial based on a pre-existing condition. Keep in mind the open enrollment starts on your 65th birthday month, and you enrolled in Medicare Part B. However, if you miss this window in open enrollment, your policy may be affected by medical underwriting. If you do have pre-existing medical conditions, it does not automatically disqualify you from medical coverage through all insurance companies. Since each insurance carrier may have different plans with different underwriting guidelines, you may be approved. There is a chance too that you could be accepted with a pre-existing condition waiting period.

What is the Pre-existing Condition Waiting Period?

If you enroll for coverage during the open enrollment, there is not a waiting period. However, if there is a gap in insurance coverage, typically there is a six-month pre-existing condition waiting period. A gap in coverage means that you did not have previous medical coverage before your enrollment. During the pre-existing waiting period, your medical costs would be paid out-of-pocket for your specified pre-existing conditions. Once your waiting period is over, your Medicare Supplement Plan should start to provide coverage for the pre-existing conditions. You should always check with your specific plan to understand the full specifications regarding pre-existing medical conditions and the waiting period. Medicare Part A and Part B typically does not have the waiting period as Medicare Supplement plans have and may cover pre-existing conditions.

Remember, if you have missed open enrollment, or if you are thinking of switching medical coverage plans outside of the Open Enrollment Period, keep the extra expense in mind.

Pre-existing medical conditions do not have to affect your medical coverage if you plan accordingly.

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