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The Facts About Medicare Quotes and Pre-existing Conditions

medicare-quotes-pre-existing-conditions

If you have a pre-existing condition, you may be hesitant to request Medicare quotes, especially without all the facts. And, if you need on-going treatment, bills can add up quickly if you don’t have the right coverage. Read on to learn important details that should help you understand your rights and make finding the right Medicare plan easier and less stressful.

What is a pre-existing condition?

The Centers for Medicare and Medicaid Services (CMS) define a pre-existing condition as “a health condition that exists before someone applies for or enrolls in a new health insurance policy”. It’s up to the insurance providers to decide which conditions qualify, and some may look at whether you’ve ever had or were previously treated for something.

Can I get Medicare if I have a pre-existing condition?

Fortunately, thanks to a new law that took effect Jan. 1, 2014, you can’t be refused coverage, denied benefits, refused treatment or charged higher rates if you have a pre-existing condition. This protection is part of the Affordable Care Act. That means, you’re still eligible for Medicare Part A and Part B based on age or specific circumstances, regardless of your health status. This protection includes things like asthma, diabetes, cancer and arthritis, a condition that the Arthritis Foundation reports more than 54 million adults are diagnosed as having by their physicians.

There’s one exception.

If you bought your policy on or before March 23, 2010, and it hasn’t significantly reduced your benefits or increased your costs, it’s considered a “grandfathered” plan and this pre-existing coverage rule doesn’t apply. If you’re not sure about your plan, contact your provider, since they’re legally obligated to share this with you.

What about Medicare quotes for other plans?

Medicare Advantage Plans, also known as Medicare Part C, are provided by private insurance companies. All of these plans include everything in Medicare Parts A and B, and many offer important benefits not included in Original Medicare, such as vision, dental, hearing, and prescription drug coverage—in one convenient plan. Generally, if you’re eligible for Original Medicare, the same pre-existing condition rules apply to Medicare Advantage Plans. That means you can’t be denied coverage or enrollment.

Medicare Advantage pre-existing condition exceptions.

If you have end-stage renal disease (ESRD), that is kidney failure requiring dialysis or a kidney transplant, you may not be eligible for Medicare Advantage plans. You may be eligible under the following circumstances:

  • You were already enrolled in Medicare Advantage when diagnosed with ESRD
  • Your current health insurance provider offers a Medicare Advantage Plan
  • You had a Medicare Advantage Plan that’s no longer offered
  • You’ve had a successful kidney transplant required as a result of ESRD and still qualify for Medicare
  • You qualify for a special type of Medicare Advantage Plan called a Medicare Special Needs Plan
Special Needs Plans

Special Needs Plans are designed for individuals with certain health conditions. These plans include all the benefits of Medicare Parts A and B, prescription drug coverage or Part D, and extra benefits to manage specific conditions.

Get Help with Medicare Quotes

Our Medicare Advocates are happy to give you a personalized Medicare quote and help you enroll in a Medicare plan that fits your needs. Contact us at 1-800-991-4407 / TTY 711 from 10 a.m. to 9 p.m. ET, Monday through Friday. You can also find, compare, and enroll in Medicare Advantage Plans at the Medicare Online Enrollment Portal.