Pre-Existing Conditions

For two years, my father was on dialysis.  Those were tough years.  When I got a client on dialysis, I wanted the best for him.  Kidney dialysis is one of the pre-existing conditions that usually excludes you from a supplement.  My client had a one-time opportunity.  I was going to make sure he got it!

Obama Care Confuses Pre-Existing Conditions

Pre-existing conditions are confusing when it comes to Medicare.  The ACA (Affordable Care Act) a.k.a. Obama Care made it more confusing because ACA covers pre-existing conditions, but ACA is not Medicare.  Different rules govern Medigap policies.  ACA applies to everyone 64 and younger.  Medigap policies are for everyone 65 and older.

Medicare Has No Pre-Existing Conditions

Medicare itself cannot deny coverage to anyone because of pre-existing conditions.  Medicare means Original Medicare.  Original Medicare is Medicare Part A for hospital and Part B for doctors and outpatient.  Medicare Part D cannot be denied for pre-existing conditions no matter the condition or cost of the medications.  Medicare Part C (or Medicare Advantage) must accept you as well, but for one exception–ESRD (End Stage Renal Disease).  You can be denied entrance to Medicare Advantage if your kidneys are permanently shut down and you are on dialysis.  All Medicare beneficiaries may enroll in a Medicare Advantage plan, except for that one pre-existing condition.

Medigap Has Pre-Existing Conditions–Sometimes

An insurance company, however, can deny you a Medicare Supplement/Medigap plan because of pre-existing conditions, except during your Open Enrollment Period or Guaranteed issue.  The rules around your Open Enrollment Period are confusing.  You can enroll in Medicare when you turn 65 and enroll in Medicare Part B.  That is called your Open Enrollment.  The time period for that is 3 months before the month of your birthday, the month of your birthday, and 3 months after your birthday.  The same term–Open Enrollment–is used for enrolling in a Medicare supplement, but the time period is different.  Open Enrollment for a supplement is from the month of your birthday and five months after.  Same term–Open Enrollment Period–but different time periods that apply to different things.  Isn’t that nice!

During your Open Enrollment Period for a supplement, the insurance company may not ask you health questions.  They must give you the best possible rate.  Even your weight is not counted against you if you are a few pounds over the normative height/weight charts.  You can be on chemo, dialysis, recovering from a stoke.  It doesn’t matter.  The insurance company MUST take you during this time period.  AFTER the six month Open Enrollment Period, they can ask health questions when you go to purchase a Medicare supplement, and based upon your answers, the insurance company could rate or even deny you.

What are some of the health questions?  Are you in a wheel chair?  Are you an insulin dependent diabetic?  Have you had a heart attack, stroke, or cancer in the past two years?  All of these questions are “knock out” questions.  If you answer in the affirmative, you will be denied a Medicare supplement.  You cannot be denied Medicare, but you can be denied the ability to purchase a Medicare supplement at any price.

Know the Rules or Find Someone Who Does

The ACA changes that permit acceptance into a health plan with pre-existing conditions created confusion in the Medicare world.  Beneficiaries need to clearly understand that a pre-existing condition can count you out of a supplement unless it is your Open Enrollment Period or Guarantee issue situation.  It is critical that persons with serious health issues be vigilant about these Medicare rules and/or find someone who will be vigilant for you.

Don’t miss your Open Enrollment Period.  If there are any questions, give us a call at 402-614-3389 or even call Medicare 800-633-4227.  Make sure you understand the rules that apply to you.

Contact: Omaha Insurance Solutions