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.

Your Medicare eligibility and coverage will not be affected

Preexisting conditions, also known as previous health conditions, do not affect your Medicare eligibility and coverage. Original Medicare (Part A and Part B) is available to any individual age 65 or older, younger than 65 with a disability, or any age with end-stage kidney disease (ESKD).1

Part C (Medicare Advantage plan) typically covers all previous health conditions except SKD (if you choose to enroll in a plan). Currently, people with ESKD are generally not eligible for a Medicare Advantage plan. However, starting Jan. 1, 2021, all Medicare-eligible individuals with ESKD can enroll in Medicare Advantage plans.

Part D (prescription drug coverage) helps cover prescription drug costs and can be added to Original Medicare as a stand-alone plan or may be included on many Medicare Advantage plans.

A Medicare Supplement insurance plan can only be added to Original Medicare

The best time to buy a policy is during your 6-month Medicare Supplement Open Enrollment Period (OEP). This period begins on the first day of the month in which you’re 65 or older and enrolled in Medicare Part B. Some states have additional open enrollment periods including for those under age 65 and eligible for Medicare due to disability or ESRD. During this open enrollment period, you can purchase a Medicare Supplement insurance plan at the same cost as others, regardless of your health.2

2 important notes to consider:

  1. After your Medicare Supplement OEP ends, your application for coverage may no longer be protected against medical underwriting. This means you could be denied coverage or charged more because of a previous health condition.3
  2. Insurance companies can’t make you wait for coverage to start if applying during OEP, but they may impose a preexisting condition waiting period before covering your previous health condition.

Your conditions can be covered

We hope we answered all of your questions about previous health conditions and Medicare. If you have any general questions about coverage, check out these 10 frequently asked questions about Medicare plans.

Sources

  1. “Original Medicare (Part A and B) Eligibility and Enrollment,” Centers for Medicare & Medicaid Services, last accessed August 18, 2020, https://www.cms.gov/Medicare/Eligibility-and-Enrollment/OrigMedicarePartABEligEnrol, opens new window.
  2. “When Can I Buy Medigap?,” Medicare.gov, last accessed August 18, 2020, https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap, opens new window.
  3. “When Can I Buy Medigap?”

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