• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer
MedicareWire

MedicareWire

Best Medicare plan, cost, and enrollment tools for seniors.

Speak with a Licensed Advisor[1]

1-855-728-0510 (TTY 711)

Mon-Sun, 8am to 11pm EST

  • Medicare Advantage
  • Special Needs
  • Medigap
  • Medicare Part D
  • More➲
    • Senior Dental Plans
    • Medicare Mistakes
    • What Does Medicare Cover?
    • Important Resources
    • Frequently Asked Questions
    • Medicare Glossary

Pre-Existing Condition

by Ethan Bynon, September 22, 2021

What are Pre-Existing Conditions?

A pre-existing condition is any health problem that occurred before enrolling in a health plan. The Affordable Care Act law made it illegal for health plans to or charge more due to a pre-existing condition. This includes Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B)., but not Medicare supplements1HHS.gov, “Pre-Existing Condition“, Accessed September 16, 2021.

Key Takeaways

  • Pre-existing conditions are chronic health conditions that exist prior to enrolling in health insurance.
  • The Affordable Care Act law prevents health insurers from denying coverage due to a pre-existing condition.
  • Without a guaranteed issue right, in most states, Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. carriers can deny coverage due to pre-existing conditions.

What Are Some Examples of Pre-Existing Conditions?

A pre-existing condition can be any health condition the beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. had before enrolling in Medicare or other health insurance. However, the term is most often associated with chronic or life-long illnesses like cancer, HIV/AIDS, heart disease, high blood pressure, and even mental health conditions such as depression and schizophrenia2Cigna.com, “What is a Pre-Existing Condition“, Accessed September 16, 2021. Health issues are considered pre-existing if it was diagnosed by a doctor before the date a beneficiary’s health insurance coverage starts, so there is no real difference between pre-existing medical conditions and existing medical conditions to Medicare2Cigna.com, “What is a Pre-Existing Condition“, Accessed September 16, 2021.

What is the Affordable Care Act?

The Affordable Care Act (ACA), sometimes also referred to as Obamacare, is a health care reform law that greatly reshaped how health insurance companies like Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. functioned in order to reduce America’s uninsured population3Healthcare.gov, “Affordable Care Act (ACA)“, Accessed September 16, 2021. Among these reforms are guaranteed issue rightsGuaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting., which mandated that people have eligibility for health insurance policies without being denied or charged higher rates due to pre-existing health conditions4Healthcare.gov, “Coverage for pre-existing conditions“, Accessed September 16, 2021.

Why Can I Be Denied Medigap Coverage?

Medigap (Medicare supplement insurance) can deny certain coverage options for pre-existing conditions because it is not health insurance. It is a form of indemnity insurance that covers the risk of a Medicare beneficiary’s out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.. A Medigap insurance carrier cannot deny coverage when beneficiaries apply for coverage with Medigap protections, also known as guaranteed issue rights5Medicare.gov, “When can I buy Medigap“, Accessed September 16, 2021.

Citations

  • 1
    HHS.gov, “Pre-Existing Condition“, Accessed September 16, 2021
  • 2
    Cigna.com, “What is a Pre-Existing Condition“, Accessed September 16, 2021
  • 3
    Healthcare.gov, “Affordable Care Act (ACA)“, Accessed September 16, 2021
  • 4
    Healthcare.gov, “Coverage for pre-existing conditions“, Accessed September 16, 2021
  • 5
    Medicare.gov, “When can I buy Medigap“, Accessed September 16, 2021

Primary Sidebar

Top 10 Medicare Mistakes in 2023

  • Thinking It’s Free!
  • Forgetting to Sign Up at Age 65
  • Not Signing Up If You Are Still Working
  • Joining an MA Plan if You Have Chronic Health Conditions
  • Getting the Same Plan as Your Spouse
  • Not Leveraging Assistance Programs
  • Choosing the Wrong Medigap Plan
  • Not Reviewing & Understanding Your Coverage
  • Going Out-of-Network in Your MA Plan
  • Costly Financial Moves when You Retire

Latest Blog Posts

Why Can You be Denied a Medicare Supplement Plan?

Medicare Plan N vs Plan G: Which Supplement is Best for You?

How Does the Plan K Medicare Supplement Work?

9 Facts About High Deductible Plan G and How it Works

Medicare Supplement (Medigap) Plans: Coverage, Costs And Eligibility

Is Plan F Still Available in 2023?

What is the Cheapest Medicare Option?

Paying for Drugs When You Have a Medigap Plan

What Does Medicare Part B Excess Charges Mean?

What is Medicare Supplement Plan N and How Does it Compare?

Footer

About MedicareWire

  • About
  • Contact
  • Code of Conduct
  • MCMG Compliance
  • Privacy
  • California Consumer Privacy
  • Disclosure
  • Personally Identifiable Health Information

[1] Licensed Sales Agent

Licensed sales agent (“advisor”) services are provided by HealthCompare Insurance Services, Inc., MedicareWire’s trusted partner. Online enrollment services are provided by MedicareEnrollment.com, a HealthCompare affiliate. Read our full sales agent disclosure.

[2] Trademark Notice

MedicareWire uses legal U.S. trademarks to identify and describe Medicare and other insurance products for shoppers. See our full trademark use disclosure.

Medicare Plan Directories

  • Medicare Advantage
  • Special Needs Plans
  • Medigap Plans
  • Medicare Part D
  • Senior Dental Plans

Copyright © 2023 MedicareWire.com - All Rights Reserved
101 W Goodwin St #2487, Prescott, AZ 86302

MedicareWire.com is a non-government website and is not endorsed by the Centers for Medicare & Medicaid Services (CMS) or any other government agency. For official government information, please visit Medicare.gov (1-800-MEDICARE). By using MedicareWire.com you agree to our Terms of Service and Privacy Policy.

Get a FREE Medigap Rate Analysis... and Save!


We'll save you money with a FREE Medicare Supplement insurance rate analysis!

The only way to know if you are getting the best deal on your Medicare Supplement insurance is to see all rates from all insurance carriers. That's what we'll send you when you fill out the form below. We won't spam you, call you, or sell your information. That's a promise!

Complete this form and we'll email your free report in 1 business day or less.

  • This field is for validation purposes and should be left unchanged.