Pre-Existing Conditions: Definition, How It Affects Insurance Costs, and Waiting Periods
If you have a health condition before you sign up for insurance, it’s called a pre-existing condition. Pre-existing conditions generally aren’t covered for a certain amount of time, and that’s called a waiting period.
Let’s say you have Atrial Fibrillation. If you signed up for a new health insurance policy, it’s very common that that policy wouldn’t cover any medical bills associated with your Afib for 6 months.
[RELATED: Can I Still Get a Medicare Supplement If I Have Atrial Fibrillation (AFib)?]
A lot of individuals understand that they wouldn’t get coverage for their condition for a while, but there’s a lot of confusion about other issues such as:
- Do pre-existing conditions make your premiums higher?
- Can you be denied insurance coverage because of pre-existing conditions?
- Are pre-existing conditions never covered by insurance?
This is all important when you start looking at senior market health insurance products like Medicare Supplements, Medicare Advantage, and Critical Illness insurances that cover things like cancer, heart attack, and stroke.
If You Buy a Medicare Supplement With a Pre-Existing Condition
Sometimes, pre-existing conditions can affect your Medicare Supplement insurance coverage.
A good portion of seniors enroll in Medicare Part B and buy a Medicare Supplement within six months of turning 65. If you do this, you have a guaranteed right to purchase any Medicare Supplement, and you can’t be turned down or charged more because of a pre-existing condition.
[RELATED: Open Enrollment vs. Guaranteed Issue (GI): What's the Difference?]
That said, there are a couple companies that will not pay for any medical bills related to your pre-existing condition for 6 months. However, if you had any form of health coverage before you applied for a Medicare Supplement (like a group plan through your work), the pre-existing coverage limitation doesn’t apply.
Another pesky detail is that most insurance companies define pre-existing conditions as any kind of condition for which medical advice was given or treatment was recommended. So, if your doctor or physician recommends any kind of treatment, even if you haven’t officially taken up that advice, it’s still considered a pre-existing condition.
Rest assured that most Medicare Supplement companies don’t have any waiting period at all for pre-existing conditions. In those situations, any medical conditions you might have are covered as soon as your policy begins.
If you do have a pre-existing condition and are worried about 6 months of no potential coverage, contact us. When you work with one of our experienced agents, they will help you choose a carrier that offers full coverage for pre-existing conditions.
If You Buy a Medicare Advantage Plan With a Pre-Existing Condition
This one’s easy – you can join any Medicare Advantage Plan even if you have a pre-existing condition. The only exception is if you have End-Stage Renal Disease (ESRD).
By law, Medicare Advantage must adhere to the same level of coverage as Original Medicare. Since Medicare won’t deny you coverage or charge you more for any pre-existing conditions, that means the same goes for Medicare Advantage plans.
If You Buy Critical Illness Insurance With a Pre-Existing Condition
Critical Illness Insurance is designed to help pay for costs associated with cancer, heart attack, and stroke. In general, there isn’t a pre-existing limitation with critical illness insurance, but there is a waiting period.
For example, many companies that offer a cancer insurance have a 30-day waiting period. This means that if you are diagnosed with cancer within the first 30 days after your policy was issued, you can’t cash in on your benefit.
Waiting periods like this are pretty common, because the insurance company is making sure you didn’t buy their policy to cover an illness you knew you had (or had a suspicion you might have). That’s why choosing to protect your finances before it’s too late is so important.
[RELATED: Can I Get Cancer Insurance If I've Had Cancer?]
Will Pre-Existing Conditions Affect Me?
If you’re concerned about how pre-existing conditions might affect your insurance coverage, please contact us! We have a team of licensed, experienced agents who are ready to assist you with all of your Medicare and retirement planning needs.
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