Senior's Introductory Guide for Navigating Medicare With Preexisting Conditions

Did you know that approximately 50% of seniors in the U.S. have some preexisting condition? This shocking statistic shows just how common preexisting conditions can be, increasing the odds that you or someone you know is living with one. The good news is that, although they have a few exceptions, Medicare covers most preexisting conditions.

Here is an introductory guide to help you navigate Medicare with a preexisting condition. 

Conditions That Qualify as 'Preexisting'

A preexisting condition refers to your diagnosed health condition before starting your health coverage. The conditions that often qualify for preexisting include:

• Cancer
• Diabetes
• Heart disease
• Epilepsy
• Asthma, etc. 

What Are Some of the Exceptions?

According to eHealth, if you have a preexisting condition and are on a Medicare Advantage or Original Medicare plan, you are generally covered for all benefits. However, the exceptions are relevant when you want to buy an insurance plan under the Medicare Supplement. This is because private companies sell the plans; therefore, it is up to those private companies whether you get denied, charged more, or experience a waiting period. This is particularly relevant to 'Grandfathered' health plans. 

Navigating Medicare With Preexisting Conditions? Some Terms to be Familiar With

While navigating Medicare with a preexisting condition, the following terms are likely to come up. Here's what you need to know about each. 

The Affordable Care Act

Thanks to the Affordable Care Act (ACA), you cannot be refused coverage or charged more by health insurance companies for having a pre-existing condition. The act also ensures one gender is not charged more than another simply because of their sex. The only exception here is grandfathered individual health insurance plans. 

Preexisting Condition Waiting Period

A preexisting condition waiting period is when your health insurance will not be paying for the care you've gone under or require for a preexisting condition. Medical policy insurers are not required to pay for those conditions' first six months of care and can undergo a 'wait time'  to start coverage.

Guaranteed Issue Right

You can avoid a preexisting condition waiting period if you buy your Medicare policy while having a guaranteed issue right. In these cases, your insurer cannot impose a wait time for coverage on a preexisting health condition. Medicare Interactive cites the following as cases where you may have a guaranteed issue right:

• Your previous Medicare Advantage Plan, PACE program, or Medigap policy ended coverage or committed fraud
• You joined a Medicare Advantage Plan upon becoming eligible for Medicare and withdrew within the year
• Through no fault of your own,  you lost a group health plan that was covering your Medicare cost-sharing

Senior Helpers Racine Is Here to Help!

When you or someone you know is navigating Medicare with preexisting conditions for the first time, taking in so much information at once can be daunting. The experts at Senior Helpers Racine are committed to sharing as much helpful information as possible to make your journey into and through senior care as smooth as possible. Contact us to learn more about our senior care services if you live in Racine, Kenosha, Union Grove, or Pleasant Prairie, WI.