Comprised of Parts A and B, Medicare is made for citizens age 65 and over.
Part A encompasses nursing care and hospital stays, while Part B gives coverage for doctor’s appointments, outpatient care, ambulances, and specific preventive care. [1]
With that said, you can be denied Medicare coverage if you have a pre-existing condition that calls for supplemental plans such as Medicare Advantage, Medigap, or prescription drug plans.
Working with Medicare Ineligibility
Original Medicare might cover pre-existing illnesses, but insurance plans under Medicare do not, so you could end up getting denied. Worse yet, there is no official list of approved conditions, so every insurance company has a different set of rules. [2]
However, you can avoid this problem by using a Medicare Part C or Medicare Advantage plan, but coverage is handled through PPOs or HMOs instead of Medicare directly. There’s no waiting period in this case and most pre-existing conditions have coverage. [3]
Medicare Supplement Plans Can Solve Your Problems
When looking for insurance, check out a Supplemental insurance or Medigap plan from Medicare which will give you extra coverage not afforded by original Medicare. [4] There are 10 standard plans such as A, B, C, etc. The same letter plans have identical benefits, but prices can vary widely among providers. You can apply by phone call, in person, or online, but don’t forget to compare out-of-pocket costs, premiums, and deductibles, as well as doctor or pharmacy restrictions.
Below we’ll outline a couple of the most important Medicare Supplement insurance benefits:
1. Medicare Supplement insurance covers much of the costs that original Medicare doesn’t cover, so out-of-pocket payments are lower.
2. Most holders of a supplement insurance plan can keep going to their pharmacy and doctor, and they don’t have to join a network or wait for a specialist.
3. Getting billed for medical services is rare because insurance companies will most often split the cost with Medicare.
4. Coverage transfers from one year to the next, so you don’t have to worry about open enrollment deadlines.
5. Coverage with a supplement plan is available across the US. You can travel and move without worrying, but some companies also cover medical expenses outside the US. [5]
Don’t Forget the Waiting Period
A pre-existing condition or disability can get you denied, but you might get medical coverage if you can wait six months. Keep in mind that any costs accrued during this waiting period and related to your pre-existing conditions can be denied. You can also skip the waiting period by applying during open enrollment, and then providers cannot deny you Medigap insurance if you have a pre-existing condition or make you pay a larger premium. [6]
You can also avoid or shorten the waiting period under the following circumstances:
1. Your provider is stopping coverage to your area’s Advantage Plan or ending its collaboration with Medicare.
2. Your job’s health plan is about to stop soon for a number of reasons including getting fired or retiring, but you have Medicare coverage.
3. You have a Select policy from Medicare along with original Medicare, but you’re moving out of coverage.
4. You’re opting out of Medicare Advantage of Medigap because you were misinformed or the insurance company didn’t follow rules.
5. Your Medigap insurance company stops coverage because they’re bankrupt or other situations out of your control.
[1] https://www.medicare.gov/what-medicare-covers
[2] https://www.planprescriber.com/medicare-faq/what-preexisting-conditions-arent-covered-by-medicare/
[3] https://medicare.com/medicare-advantage/do-medicare-advantage-plans-have-guaranteed-issue-rights/
[4] https://medicare.com/medicare-advantage/medicare-advantage-vs-medicare-supplement-how-to-choose/
[5] https://www.mutualofomaha.com/medicare-supplement-insurance/benefits
[6] https://www.medicaresupplement.com/articles/medigap-with-preexisting-condition/