I Have a Pre-Existing Condition, What are My Medicare Supplement (Medigap) Rights?
If you have a pre-existing condition, you may have found it difficult to enroll in an insurance plan in the past. Now that you’re nearing age 65 – or perhaps you’re already there – you want to be certain that it’s an option for you to get a Medicare Supplement plan along with Original Medicare. You just aren’t sure that Original Medicare is going to be enough for your healthcare expenses, and you don’t want to worry about what lies ahead or play any games when it comes to your wellbeing.
Let’s take a look at what a pre-existing condition is to start.
WHAT IS A PRE-EXISTING CONDITION?
A pre-existing condition is a health problem that you had prior to starting healthcare coverage. It can be anything from asthma or diabetes to cancer, sleep apnea or depression. Usually, a pre-existing condition is something that is chronic or long term. When the Affordable Care Act passed, it became illegal for companies to deny people coverage based on pre-existing conditions, as they had done in the past. With that said, however, insurers can still put a waiting period on new enrollees with a pre-existing condition.
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WHAT IS A MEDICARE SUPPLEMENT PLAN?
Medicare Supplement planscover procedures, prescriptions, services and other necessary healthcare items that Original Medicare does not. Original Medicare – also called Medicare Parts A and B – covers things like lab tests, home health care, skilled nursing facilities, inpatient hospital care, surgery, hospice, outpatient care, durable medical equipment and some preventative services.
A Medicare Supplementplan, which is also referred to as Medigap coverageor MedSupp, will take care of various expenses depending on which plan you’re enrolled in. In most states throughout the U.S., you will be able to choose one of 10 different plans, which are labeled A, B, C, D, F, G, K, L, M, and N. Typically, the benefits across each state will be the same, but sometimes they may be different. When purchasing your Medigap coverage, make sure you read all the fine print before signing the dotted line.
Once you turn 65, you can enroll in Original Medicare, and then you can also sign up for the benefits of a Medicare Supplement plan, which include the following:
- Part A hospice care coinsurance or copayment is covered 100% by most of them, except for K, which covers 50%, and L, which covers 75%
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up is covered by all of them
- The Part B excess charge is covered by only plans F and G
- Skilled nursing facility care coinsurance is covered 100% by C, D, F and G, 50% by K and 75% by L
While Plans C and F are considered the ones with the most comprehensive coverage, unfortunately, they are not accepting new enrollees starting on January 1, 2020. If you enroll before then or you’re already enrolled, you will get to keep your plans, however.
Once you’ve decided on which Medigap coverageyou want to pursue, you can then look into reporting your pre-existing condition and how it will affect your coverage.
CAN YOU ENROLL IN A MEDICARE SUPPLEMENTPLAN WITH A PRE-EXISTING CONDITION?
When it comes to enroll in Medicare Supplement plans with a pre-existing condition, you’re may have to wait up to six months before you start receiving coverage. Under the law, Medicare Supplement plan providers can only delay your coverage for health conditions that were treated or diagnosed within six months before your Medigap coverage starts.
Your best plan of action is to apply for a Medicare Supplement plan during open enrollment, which starts on the first day of the month you’re at least 65 years old and enrolled in Medicare Part B. It lasts six months. As a benefit, your guaranteed issue rights are 100% guaranteed during this period, and you can enroll without having to experience a waiting period. Outside of it, you will only have guarantee issued rights in certain situations. If you purchase Medigap coverage during the period when you have guaranteed issue rights, the insurance company cannot place a pre-existing waiting period on you.
Along with avoiding the pre-existing condition waiting period, if you enroll in Medigap coverage within six months of signing up for Original Medicare, you can ensure you will be covered for any healthcare expenses that arise because of your pre-existing condition. The longer you wait to enroll, the more healthcare expenses you may have to pay out-of-pocket. Original Medicare will still cover you, but it may not pay for things like coinsurance, copayments, or if you are receiving treatment for an excluded condition.
If you can, you should delay any appointments and treatments until you start receiving Medigap coverage following the waiting period. If you cannot delay, make sure you’re saving up money for the out-of-pocket expenses you’re going to incur. Your health is number one, so don’t delay anything that is necessary to your wellbeing.
Outside of open enrollment, there are a few other ways to get around the waiting period. The first is if you’ve experienced a qualifying event, like the loss of retiree health coverage.
The second way to avoid or shorten a waiting period is if you have a pre-existing condition and you’re replacing “creditable coverage.” This involves purchasing a Medicare Supplement plan during your Medigap open enrollment period and replacing creditable coverage. If you’ve had at least six months of prior creditable coverage, a Medigap coverage provider cannot make you wait before it decides to cover your pre-existing condition. There are numerous types of health care coverage that qualify as creditable coverage for Medigap plans, but they will only count if your break from coverage was no more than 63 days.
Another loophole is that four states, Connecticut, New York, Maine, and Massachusetts, will protect Medicare Supplement plan applicants beyond the open enrollment period. An applicant’s medical history does not matter; they will receive annual or continuous guaranteed issue protections.
If you’re searching for a Medicare Supplement plan, you may find that some don’t require any waiting period. Make sure that you weigh the pros and cons of going with a plan without a waiting period vs. one with a waiting period, but with better coverage. What’s most important is that you get the most extensive coverage possible.
ENROLLING IN A MEDICARE SUPPLEMENT PLAN WITH A PRE-EXISTING CONDITION
As soon as you can sign up for Original Medicare, take advantage of that open enrollment and guaranteed issue rights period before it expires. If you’re not already enrolled in Original Medicare, look at what it covers, and what types of care you are going to need for your pre-existing condition. Keep in mind that as you age, your condition may become worse, which will require more care and result in additional expenses. You want to plan as far ahead as you can. Remember to keep in mind that Medigap coverageusually costs between $2,000 and $7,000 per year. When you add up the out-of-pocket expenses that your Medicare Supplement plan may not cover, you may be putting thousands of dollars towards your health care. If you need to switch yourMedigap coverage, make sure you ask your new plan provider if there is going to be a waiting period. Again, you don’t want to have to wait to get to those crucial appointments or pay out of pocket.
If you’re ready to start looking for Medicare Supplement coverage, use Ensurem’s Medicare Supplement Quote tool. Simply enter your information like your birthday, gender, zip code and tobacco use, choose your search options – which include the various plans and their associated costs – and then click enter. Within one minute, you will see all your options for enrolling. You may even receive a percentage of the Medicare Supplement plan on a discount depending on your situation. Your benefits may include low out-of-pocket costs, rarely receiving a bill for covered services, getting emergency care anywhere around the world, not having to go through referrals or provider networks, and keeping your coverage as long as you pay your premiums on time.
What are you waiting for? Sign up for a Medicare Supplement plan today that will help you treat your pre-existing condition and bring you the care you deserve.
Ensurem Trusted Expertise
Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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