Have Pre-Existing Conditions? Your Guide to Getting a Medicare Supplement Plan

Having a pre-existing condition used to be a serious problem for people looking for health insurance. Fortunately, the passage of the Affordable Care Act in 2010 changed that for people purchasing private insurance. But what about Medicare beneficiaries? Medicare Parts A and B cover anyone who paid into these programs, but what about Medicare Supplement Plans? Can you be denied for these plans – or charged more for one – if you have a pre-existing condition? With pre-existing conditions affecting an estimated 53.8 million adults 65 and older, this is an important question.article title and clipboard that says pre-existing conditions on a blue background

What Is Considered a Pre-Existing Condition?

Almost any illness or injury you had prior to enrolling in your insurance plan can be considered a pre-existing condition. The list is long but some of the most common ones are cancer, diabetes, end stage renal disease, and stroke. Not all pre-existing conditions are as serious, though: things like asthma, sleep apnea, and lupus can be pre-existing, too.

When it comes to Medicare specifically, for a condition to be considered a pre-existing, you have to be diagnosed and begin treatment before your Medicare start date. Even if you don’t receive a diagnosis before enrollment, your condition can still be count as pre-existing. For example, if you have a condition with emergent symptoms that the average person would have already had treated, your insurer can classify it as pre-existing. 

What Are Medicare Supplement Plans? 

Medicare Supplement Plans are insurance plans offered by private companies. They help cover the out-of-pocket costs of Original Medicare. While Medicare covers most of your health services it won’t cover everything: for example, Medicare Part B only covers 80% of medical services, leaving you to pay a 20% coinsurance. But if you have a Medicare Supplement Plan, this coverage will kick in and pick up the remaining costs.

Medicare Supplement Plans cover a number of things like copays, coinsurance, and deductibles, meaning you’ll only have to pay a low monthly premium. Some Medicare Supplement Plans even cover care you receive outside of the country, which Original Medicare won’t cover at all. 

Can I Get a Medicare Supplement Plan with a Pre-Existing Condition?medical record paperwork on desk

Fortunately, the answer to this is yes! You can get a Medicare Supplement Plan even with pre-existing health issues. Companies that offer these plans are usually able to use underwriting to determine your eligibility. Luckily there is a way around it. It all depends on when you sign up for your plan.

The best time to get a Medicare Supplement Plan without worrying about being denied or paying more for your plan because of health issues is during your Medicare Open Enrollment Period. This period begins the first day of the month your Medicare Part B. And is in effect and lasts for 6 months. 

Your Open Enrollment Period is the best time to get Medicare Supplement Insurance with pre-existing conditions. During this time, you have something called a guaranteed issue. This means that insurers have to offer you the best rates available. And they can’t deny you based on your health.

If you miss your Open Enrollment Period, you can still get a Medicare Supplement Plan.  But you may run into problems like high premiums or a 6-month waiting period. This means that you will have to pay for expenses related to your pre-existing condition for 6 months. Once that waiting period is over, your Medicare Supplement Plan will start covering your costs as normal.

Some states do offer additional enrollment periods though, so check with your state’s Medicare office. Additionally, if you qualify for a Special Enrollment Period, you can skip the pre-existing condition waiting period.

How Do I Qualify for a Special Enrollment Period?a bunch of gray question marks piled together with one blue and one orange question mark in the pile

 If you’ve missed your Open Enrollment Period, you can still get a plan with the better rates. There are a number of circumstances that can trigger a Special Enrollment Period. During which you can get a new Medicare Supplement Plan:

  • Your employer’s supplemental insurance ends, or benefits are reduced
  • Your Medicare Advantage Plan changes or ends its terms
  • You move out of your plan’s coverage area
  • Your Medicare Supplement Plan insurer commits fraud
  • You are utilizing your “trial right” within 12 months of applying for a Medicare Advantage Plan for the first time

Need Help?

Enrolling in a Medicare Supplement Insurance plan with pre-existing conditions can be tricky. If you need help navigating the enrollment process, EZ.Insure is here to help! Our highly trained insurance agents are always available to help you with any questions. We also provide free instant quotes. Simply put your zip code in the bar above, or you can speak to an agent directly, just call 888-753-7207.

Co-written by Brianna Hartnett

What To Do If Your Medicare Supplement Insurance Plan Is Discontinued

Medicare does not cover 100% of all medical expenses, which is why many people choose to purchase a Medicare Supplement Plan. A Medicare Supplement Plan will cover whatever out-of-pocket costs are left after Medicare has paid its part – and if you have a Medicare Supplement Plan, you know just how much money this can save you. That means you’re probably pretty happy with your plan – but what if you get a notice that you need to change your Medicare Supplement Plan because it is getting discontinued? Why would this happen and what can you do about it?

Reasons Your Plan Could Be Discontinuedbankruptcy types on a piece of paper on a typewriter

Typically Medicare Supplement Plans are not discontinued, but it can happen in certain cases. For example, if:

  • Your insurance company files for bankruptcy
  • Your insurance company goes out of business
  • You gave false information when applying for your plan
  • You fail to make your monthly premium payments

Before your plan is discontinued, you will receive notices, emails, and letters that your plan is ending.

The Next Steps 

If you receive notice that your plan is going to be canceled, the first thing you should do is make sure you keep your notice of termination in your records, so you have it when you are looking for a new plan. Also, it is important to note that if you lose coverage due to nonpayment or because you have given false information, you will not have the same outcome as you will if you lose your plan due to something out of your control, such as your insurance company going under. 

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If you have guaranteed issue rights, then you will have 63 days from when your coverage ends to get a new plan.

If you lose your plan due to circumstances beyond your control, you have the right to buy a new plan: this is known as a guaranteed issue. Guaranteed-issue rights protect you from having to undergo medical underwriting, or the process by which an insurance company collects information regarding your health history to decide whether to issue you insurance, to get a new plan.

If you do have guaranteed-issue rights, the only thing you need to do is to find a new Medicare Supplement Plan within 63 days from the day your coverage ends. You will need your letter of discontinuation for proof that you have special circumstances, and you can begin shopping for a new plan. 

If you lost your Medicare Supplement Plan due to nonpayments or giving false information, you can try to purchase a new plan, but you will not have guaranteed-issue rights, meaning you will face medical underwriting. This could mean denial or increased monthly payments due to pre-existing conditions. However, if you work with an EZ agent, we can find you an affordable rate for a Medicare Supplement Plan by comparing all available plans in your area. 

If you are looking for a new plan because your Medicare Supplement Plan is being discontinued, EZ can help. Our agents work with the top-rated insurance companies in the country, so we can easily compare plans in your area in minutes. We will help you find a Medicare Supplement Plan that fits your budget and meets your medical needs, so you can start saving money. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Will I Have to Answer Questions About My Health When Applying for a Medicare Supplement Plan?

Medicare Supplement Plans can help you save hundreds, or even thousands of dollars on medical expenses every year, but you do need to know the best way to apply for a plan, and that includes knowing when to apply. While you can get a Medicare Supplement Plan at any time, the best time to do so is during your Open Enrollment Period: if you apply at this time, you will receive a waiver for health question requirements, but if you miss it, or want to change your plan outside of your guaranteed issue time frame, you will have to undergo the underwriting process, and will be asked a series of questions about your health in order to qualify for coverage.

Guaranteed Issue Explained

a clock next to a form with a pencil checking off a box
If you miss your Open Enrollment Period, then you will no longer have guaranteed issue right, and have to undergo the underwriting process.

If you choose to buy a Medicare Supplement Plan during your Open Enrollment Period, you will be given guaranteed issue, meaning you will not have to undergo the underwriting process. Your Open Enrollment Period starts three months before you enroll in Medicare Part B, and continues through the month you turn 65 and the 3 months after you turn 65. During this time you will not have to answer any questions about your health, and will be guaranteed approval for a Medicare Supplement Plan, regardless of your health status. 

If you do have to undergo the underwriting process because you do not qualify for guaranteed issue, you should know that every insurance carrier will ask you health-related questions on your application. Each company will have a different set of questions: one might ask if you have ever had a certain health condition, while another might ask you about your more recent health status. 

Common Health Questions

If you are generally in good health, and can answer “no” to most of the questions about having certain health conditions, you will most likely be approved for a plan. On the other hand, the more you answer “yes” to these health questions, the more likely you are to be denied by most insurance companies. 

Some of the health questions you will most likely be asked include:

  • Are you confined to a wheelchair or motorized mobility device?
  • Do you have any minor health issues such as arthritis, cholesterol or high blood pressure? You can still be approved for a plan if you answer “yes” to this question, as long as the minor health issue is not accompanied by a more serious problem. In addition, you can still get approved even if you are slightly overweight, as long as you are not considered morbidly obese. 
  • Have you been advised to undergo any medical treatments in the past 2 years, or are you scheduled to have surgery? Insurance companies will not want to take you on as a risk if you are undergoing treatments for serious medical conditions, or if you are planning to have surgery. Most will want you to complete your treatments and undergo surgery first before you apply for a Medicare Supplement Plan. 
  • Do you currently have any lung or respiratory disorders or are you currently using tobacco products? older adult in a wheelchair with a person holding their arm
  • Are you currently hospitalized, or are you confined to a nursing home or assisted living facility? If you have received home health care services two or more times within the last couple of years, insurance companies might deny your application; in addition, if you live in a nursing home, you will most likely not get approved. 
  • Do you currently have or have you had cancer? If you have had cancer, most insurance companies will want you to be cancer-free for at least 2 years before they will consider covering you; you must be in remission, and be a few years past any surgeries. 
  • In the past 2 years, have you been treated for or been advised by a doctor to have treatment for any of the following? Having chronic lung problems, dementia, immune deficiency disorders, Parkinson’s disease, osteoporosis, stents, strokes, heart attack, pacemakers, or congestive heart failure will mean that you will probably be denied.different medication pills in a pile.
  • What medications are you currently taking? Some insurers have a list of medications that result in automatic denials. 
  • Do you have diabetes with complications including neuropathy, or any heart disorder? If you have diabetes, some insurers will ask specific questions to determine how serious it is. For example, they might ask: Do you have diabetes with high blood pressure and require three or more medications to control your blood pressure? Or: Does your diabetes require more than 50 units of insulin each day to control?

Make sure that you answer all the questions truthfully, because insurance companies will see a copy of your medical records to confirm your health status. And remember, even if you do get denied by one insurer, you might still be able to find another insurer that will cover you. The best way to find out if you qualify for a Medicare Supplement Plan is to work with an EZ agent: our agents work with the top-rated insurance companies in the country, so they will be able to compare all plans from different insurance carriers to find one that does cover your medical needs. You do not have to go through this process alone! To get free instant quotes of plans that covers your doctors, simply enter your zip code in the bar above, or to speak to an agent, call 888-753-7207.