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Learn the Lingo: What Is a Pre-Existing Condition and How Does It Affect My Insurance?

Learn the Lingo: What Is a Pre-Existing Condition and How Does It Affect My Insurance?

According to Medicare.gov, a pre-existing condition is a health problem you had before the date that a new insurance policy starts.

For example, if you have diabetes when you apply for a Medicare Supplement, diabetes would be considered a pre-existing condition.

[RELATED: Can I get a Medigap Plan If I Have Diabetes?]

That’s easy enough to understand, but how do pre-existing conditions affect your insurance?

  • Do pre-existing conditions raise your rates?
  • Can you be denied insurance coverage because of pre-existing conditions?
  • Are pre-existing conditions not covered by insurance?

This is all important when you start looking at senior market health insurance products like:

Pre-Existing Conditions and Medicare Supplements

Some of the time (though rarely), pre-existing conditions do affect your Medicare Supplement insurance coverage.

If you enroll in a Medicare Supplement insurance plan within six months of turning 65, and you’re enrolled in Medicare Part B, you have a guaranteed right to purchase any Medicare Supplement insurance plan sold in your state. In this very common situation, you cannot be turned down or charged more because of a pre-existing condition.

[RELATED: Learn the Lingo: What does “Guaranteed Issue” mean?]

Pre-Existing Conditions and Medicare Supplements


That being said, there are two companies in the state of Illinois that will not pay for any medical bills related to your pre-existing condition for 6 months. Don’t worry – if you had some form of credible coverage before applying, such as group health insurance through your employer, the pre-existing coverage limitation does not apply.

Medigap companies define a pre-existing condition as “a condition for which medical advice was given or treatment was recommended by or received from a physician within six months prior to the policy effective date.”

So, here’s an example.

Let’s say you’re diagnosed with Type II diabetes in May. You’re approved for a Medicare Supplement in August. You won’t be able to get any health coverage for your diabetes until February of the following year.

However, most Medigap companies don’t have any waiting period at all for pre-existing conditions. In those situations, prior medical conditions are covered as soon as your policy is issued.

If you do have a pre-existing condition and are worried about that 6 months of no 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.

Get in touch with an experienced agent today.

Pre-Existing Conditions with Medicare Advantage

You can join a Medicare Advantage Plan even if you have a pre-existing condition. The only exception is End-Stage Renal Disease (ESRD).

By law, Medicare Advantage must provide the same level of coverage as Original Medicare. Original Medicare will not deny you coverage or charge you more for a pre-existing condition, which means the same goes for Medicare Advantage plans.

Pre-Existing Conditions with Medicare Advantage


Pre-Existing Conditions with Cancer Care Insurance

Cancer Care Insurance is designed to help pay for costs associated with cancer, heart attack, and stroke.

There are 2 different types of critical illness insurances: lump sum and benefit-specific policies.

Lump sum policies are very simple. For example, you might pay $30 per month for a $10,000 benefit. That means that as soon as you’re diagnosed with a disease like cancer, you get paid $10,000. You get to choose how to spend that money.

Benefit-specific policies are different in that they pay for services that are approved in your outline of coverage. For example, the policy might pay $100 for every day you’re in the hospital or $100 for every day of radiation.

Lump sum policies are generally more desirable because you can use the money as you see fit. With benefit-specific policies, you don’t have that luxury.

Pre-Existing Conditions with Cancer Care Insurance


In general, there isn’t a pre-existing limitation, but there is a waiting period.

For example, many companies that offer a Cancer Insurance policy have a 30-day waiting period. This means that if you are diagnosed with cancer in the first 30 days after your policy has started, you cannot receive a benefit.

Waiting periods like this are quite common in insurance because the insurance company is making sure you didn’t get a suspicion and then immediately go buy an insurance policy. That’s why choosing to protect your finances before it’s too late is so important.

[RELATED: Should I Buy Cancer Insurance?]

What next?

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.

It never hurts to make sure that your health insurance coverage is comprehensive, so simply click on the button below to call us or send us a message.

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