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What If You Have a Pre-Existing Condition?

Are a Connecticut resident? Do you plan to stay one for the upcoming year? If “yes,” you can probably relax. If you maintain continuous coverage, your medical history isn’t likely to affect you.

You will only see one medical question on an application for a Medicare Advantage Plan. I haven’t seen any medical questions on Connecticut Medicare Supplement Plan applications.

Your medical history will only hurt you one of these two things is true. You did not maintain continuous “creditable” coverage. You have end stage renal disease (ESRD).

Most group health insurance policies are “creditable.” All Medicare Advantage Plans and all Medicare Supplement plans are also. They meet Medicare’s minimum standards. They qualify as solid coverage.

ESRD is kidney disease requiring dialysis or a transplant.

Unless you have this condition or a coverage lapse, your carrier cannot say “no” to you because of a health condition.

You will be able to switch plans with no pre-existing condition problems…

Unless you move out of state.

Not every state has the same “guaranteed issue” rules. Connecticut has some of the most favorable regulation in the country. (Contact a broker in the other state to hear about their rules.)

If you plan to move, and the companies in the other state might deny you, there is a solution. You can switch to a Medicare Supplement Plan before you move.

These plans are portable. You can take it with you. You cannot take your Medicare Advantage Policy to another state.

(Your Medicare Advantage Plan will cover your medical emergencies when you travel to another state for a visit. You just can’t keep it if you move to another state.)

You can switch from a Medicare Advantage Plan to a Medicare Supplement Plan two times of the year. You can switch during the Annual Enrollment Period – October 15th to December 7th. You can switch during the Medicare Advantage Disenrollment Period – January 1st to February 14th.

What If You Haven’t Had Continuous Coverage?

You can apply for a Medicare Advantage Plan during the Annual Enrollment Period. Your preexisting conditions won’t block this unless you have ESRD.

You can apply for a Medicare Supplement Plan any month of the year, but you may have to wait a few months before pre-existing conditions are covered.

What If You Are New to Medicare?

If you are new to Medicare because you are about to turn 65, only ESRD can be held against you. You will not have a waiting period before all your conditions are covered on any plan otherwise.

If you have ESRD, you will not qualify for a Medicare Advantage Plan. You won’t have a waiting period for full coverage if you apply for a Medicare Supplement.

If you are new to Medicare because you are losing employer-sponsored group coverage, the same rules apply.

By the way, you cannot be charged extra due to a pre-existing medical issue.

About Post Author

Alston J. Balkcom

“ Connecticut-licensed insurance agent since 1985.”