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Every year, hundreds or even thousands of Americans turn 65 who also become a Medicare beneficiary. Many of them are fortunate enough to get into Medicare in a wholesome health, while others are not.
Like the one whom I talked with a few months ago, “my wife is turning 65 this coming September, but…”
He told me that they just found out that his wife is suffering from a heart valve disease and will soon require an operation. He is worried that his wife could not have any other insurance other than Original Medicare (Part A and Part B), especially when she won’t be under his medical insurance anymore.
That “but” always make me a little nervous, as it always entails undesirable details afterward.
The husband’s anxiety towards the condition of his wife is understandable. In fact, a lot of people with pre-existing conditions feel the same way as they approach the age of 65. But favourably, there is an insurance policy that accepts enrollees with pre-existing conditions aside from Medicare.
What is a pre-existing condition?
Pre-existing conditions are any health condition, injury, illness, sickness, disease, disabilities or other physical, mental, medical or nervous condition that you have acquired before your application or the start of coverage of your new insurance policy.
Does Medicare cover pre-existing conditions?
Yes, it does!
I got to give the husband the good news that the condition of his wife would be covered by Original Medicare from the start. Fortunately, there are no pre-existing condition limitations when you first enroll in Medicare otherwise people will dread to retire.
The husband that I had a chat with is on the right path by planning ahead not just for himself, but most importantly for his wife who has pre-existing conditions. He took an advantageous step because Medicare often leaves its beneficiaries a huge gap in coverage. If he did not take the step to plan ahead, he won’t know of the gaps and would probably not know the solutions to cover the gap. Even if he does, it would be probably too late.
Medicare covers up to 80% of your health care expenses. The rest will serve as your out-of-pocket expenses. Over time, this may add up to one another and could be a burden, especially to someone with the pre-existing condition who might require a lot of medical attention.
What is Medicare supplement insurance?
Medicare Supplement insurance or Medigap, are insurance policies that supplement the coverage of Original Medicare. It is offered by private insurance companies and has monthly premiums that you need to pay aside from the one for Medicare Part B.
Depending on the type of plan, it will cover all or part of the Medicare-covered health care costs that were left by Original Medicare. That includes deductibles, copayments or coinsurance.
Do Medicare Supplement insurance cover pre-existing conditions?
Yes! Provided that the applicant will buy the policy during his or her Medicare supplement open enrollment period.
His wife (and all the other Medicare beneficiaries) could buy Medicare supplement plan as long as she does it within six months upon enrolling in Medicare and Medicare Part B. Medicare supplement open enrollment period is a very critical period especially to someone who has pre-existing conditions. Because, only during this time, they can buy a policy with guaranteed approval rights. Meaning, Medicare beneficiaries with pre-existing conditions won’t have to answer medical questions or undergo medical underwriting.
Furthermore, only during this period that insurance companies are not allowed to charge applicants higher premiums because of their conditions.
What if I enroll in Medigap AFTER my open enrollment period?
Keep in mind that if you wish to enroll in Medicare supplemental insurance after your enrollment period:
- Insurance companies might reject your application.
- If the insurance provider accepts your application, you may have to answer medical questions or undergo medical underwriting. Also, you might have to wait for about 6 months before they cover your pre-existing conditions.
- Insurance companies might charge you a more expensive premium.
Other rules apply to those who want to switch plan from Medicare advantage to Medicare Supplements.
People with Original Medicare have Medigap as their source of supplemental coverage
In 2015, about a quarter of traditional Medicare beneficiaries has Medicare supplement plan to help them cover the gaps of Medicare and limit their out-of-pocket costs for Medicare-covered expenses.
Now, the numbers kept growing and reached more than 13 Million Medicare beneficiaries who chose to trust Medigap as their source of supplemental coverage for 2018.
Final words. Medicare Part A and Part B (Original Medicare), are already helpful in paying for your medical expenses. However, having pre-existing conditions might be another story. Do know that Medicare does not cover everything, including prescription drugs, deductibles, copays etc. Therefore, having a Medicare supplement plan and a prescription plan may be a good policy to acquire to cushion you from expenses, once you turn 65.
The husband from the story that I shared earlier, decided to take a look at Medicare supplements. He is also considering to have her enroll in one of the plans in addition to prescription coverage.