With health insurance comes the question of covering preexisting conditions. Traditionally, private health insurance companies either did not cover such diseases or charged higher premiums.
Medicare-type plans, which afford health insurance for senior citizens, generally do not turn you away or make you pay more because you might have diabetes, cancer, or some other disease when you enroll. However, guaranteed coverage for preexisting conditions depends on the type of Medicare plan you have.
Medicare Parts A and B
The traditional Medicare coverage (A and B) pays for your hospital stays and visits to the doctor. You become eligible for Medicare when you turn 65 years old. That you have pre-existing conditions does not make you ineligible, and you get benefits for hospital and physician visits to treat these conditions.
Your application for Social Security retirement is also your application for Medicare A. Coverage starts automatically when you reach age 65 or start receiving Social Security retirement. Medicare can be complicated so be sure to have a good friend on your side that can help out. That way, you will be able to make the best of it. Also, you will be able to get your Medicare taken care of in a timely and organized manner.
As with original Medicare, pre-existing conditions generally do not prevent you from getting a Medicare Advantage Plan. Further, providers of Medicare Advantage cannot charge you higher premiums based on having a pre-existing disease or disorder. As of January 2022, those with ESRD may enroll in Medicare Advantage plans.
Medicare Advantage affords coverage that you will not find with just Medicare Parts A and B. Sometimes called “Part C”, Medicare Advantage pays for prescriptions, hearing, vision, and dental care. Unlike original Medicare, the federal government does not operate Medicare Advantage plans. You get these from private health insurance companies that provide benefits subject to federal regulations.
As compared with Medigap, which we’ll touch upon below, Medicare Advantage comes with lower premiums. You might experience more limited choices for hospitals and physicians than with Medigap. Generally, you can only use providers in a particular network. This is incredibly important to remember, so be sure to write it down for future reference. There is always time to investigate Medicare Advantage and all of its details, especially if you have reached that age. Having Medicare can help you in many various ways. Your healthcare will stay solid if you can get taken care of under Medicare.
Medicare Supplement Plans
Medigap plans, also known as Medicare Supplement plans, cover vision, dental, hearing, and other things not included in original Medicare A and B. It typically carries higher premiums than Medicare Advantage, but you can use Medigap with more medical providers.
Medigap will cover pre-existing conditions if you apply for it during the “Open Enrollment Period.” This is a six-month period that begins on the first day of the month in which you both turn 65 years old and become eligible for Medicare Part B. Note that the period does not start necessarily on the date that you turn 65. This is incredibly important to remember, so be sure to write this down as well.
If you miss the open enrollment period, you may still get pre-existing coverage for Medigap if you have “guaranteed issue rights.” These rights extend to those who:
- Have Medicare Advantage aged 65 or older who go back to original Medicare
- before the end of the trial period of 12 months
- Lose Medicare Advantage due to the plan’s termination or move out of an area
- served by Medicare Advantage
- Have an employer-sponsored supplement to Medicare terminated
- Have a current Medigap plan that ends
Medicare and End-Stage Renal Disease
End-Stage Renal Disease (ESRD) manifests itself in kidney failure which requires you either to have a kidney transplant or constant dialysis. If you have such a pre-existing condition, Medicare Part A and B cover the hospital stays and physician’s services for the ESRD. Traditional Medicare pays regardless of your age if you suffer from kidney failure, need dialysis, or have a kidney transplant, and you either have worked enough to get Social Security retirement or are getting Social Security.
As of January 1, 2021, Medicare Advantage plans afford coverage for those with ESRD. Prior to it, you generally could not get Medicare Advantage for a pre-existing ESRD. This is a great advantage for those patients that are suffering from this particular ailment.
The Centers for Medicare and Medicaid Services (cms.gov) offer a good starting point to learn about your Medicare options. You can also contact Medicare Advantage or Medigap (Medicare Supplement) providers or a trusted agent about preexisting conditions and enrollment in the right plan for you. With health insurance comes the question of covering preexisting conditions. Traditionally, private health insurance companies either did not cover such diseases or charged higher premiums.