Yes, a big benefit of Medicare, especially as you get older, is that you can’t be denied coverage or charged more because of preexisting medical conditions. Plus, if you’re younger than 65 and have certain medical conditions, you may be able to qualify for Medicare coverage early.
Most people younger than 65 who receive Social Security Disability Insurance (SSDI) benefits can qualify for Medicare 24 months after they become eligible for disability benefits. And people younger than 65 may qualify for Medicare without the 24-month waiting period if they have permanent kidney failure, also known as end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig’s disease.
Does Medigap cover preexisting conditions?
Maybe. The rules are different for Medigap coverage, a federally regulated private insurance that many people with traditional Medicare buy to help pay Medicare’s deductibles and copayments. If you’re 65 or older, federal law allows you to buy a Medicare supplement policy with full protections if you do so within certain specified time frames.
Everyone 65 and older on Medicare qualifies for these protections, known as guaranteed issue rights, for the six-month period after you enroll in Medicare Part B benefits. That means insurance companies cannot refuse to sell you a Medigap policy or charge you higher premiums based on your current health or medical conditions. Some people qualify beyond that time frame; see details below.
If you apply for a Medigap policy when you don’t have a guaranteed issue right, you’ll usually have to answer questions about your health. An insurer may reject you or charge more if you’ve had certain medical conditions, usually within the past two years. But the conditions, timeframe and effect on your coverage can vary a lot by insurer and state.
When do I have a Medigap guaranteed issue right?
An insurance company can’t refuse to sell you a Medigap policy because of past or present health problems if you qualify for Medicare when you’re 65 or older:
For six months starting the month you sign up for Medicare Part B when you’re 65 or older. You’ll get the best price for any policy in your area based on your age, gender and smoking status.