Does Medicare cover preexisting conditions?

If you suffered an injury or illness before becoming eligible for Medicare, you may wonder if it will affect your eligibility or coverage options.

Here’s a look at how Medicare works with preexisting conditions.

What is a preexisting condition?

Preexisting conditions are health problems you had before applying for or enrolling in a new insurance plan. Some can be chronic diseases, such as diabetes, high blood pressure or cancer. Others can be mild conditions, such as seasonal allergies or acne.

Medicare coverage for preexisting conditions

Original Medicare (Part A and Part B) has helped cover preexisting conditions since it began in 1965. And thanks to the Affordable Care Act signed in 2014, there are no additional costs for Original Medicare coverage if you have preexisting conditions.

Let’s see how these conditions are handled by the different parts of Medicare.

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Does Original Medicare cover preexisting conditions?

Yes. When you sign up for Original Medicare, any preexisting condition will be covered immediately. You’ll still be responsible for all out-of-pocket expenses like deductibles, copayments and coinsurance.

Does Medicare Advantage cover preexisting conditions?

Yes. Medicare Advantage (MA) plans won’t reject your enrollment if you have a preexisting condition. But since MA plans are offered by private insurance companies, coverage levels and costs can vary from company to company.

Do Medicare Supplement insurance plans cover preexisting conditions?

Yes. However, a Medigap insurance company can refuse to cover pre‑existing conditions for up to 6 months after enrollment. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover those conditions.

Note: The only way Medigap coverage can be denied for a pre-existing condition is if the condition was treated or diagnosed during the “look back period”—6 months before your Medigap policy coverage started.

Your conditions can be covered

Original Medicare, provided by the U.S. Government, does help cover preexisting conditions. Medicare Advantage and Medigap plans, which are offered by private companies, have their own rules. To learn about Medigap plans with Humana, check out our Medicare Supplement Insurance plans today.

Frequently asked questions

1. Is there a minimum waiting period for a preexisting condition under Medicare?

Not for everyone. In some cases, a Medigap insurance company can refuse to cover out‑of‑pocket costs for preexisting health problems for up to 6 months. This is called a “preexisting condition waiting period.” After 6 months, the Medigap policy will cover the preexisting condition.¹

2. When can I switch Medicare Advantage plans with a preexisting condition?

If you’re currently enrolled in a Medicare Advantage plan, you have 2 enrollment periods per year to switch plans: The Open Enrollment Period (Oct. 15 – Dec. 7) and The Medicare Advantage Open Enrollment Period (MA OEP) (Jan. 1 – March 31).

3. Can you change Medicare Supplement plans with preexisting conditions?

Yes. If you’ve had your current Medigap policy for under 6 months, you can switch to a different Medigap policy. However, you may have to wait up to 6 months before any new benefits start or your preexisting condition will be covered.²