No one can control when they get sick. And yet, we’ve all heard horror stories of insurance companies denying applicants with pre-existing conditions from coverage. For example, if you have long-term care insurance policies typically won’t take on new clients who are already very sick. Knowing this, you may be wondering if Medicare covers pre-existing cancer. And, will they charge you more because you have cancer? Keep reading to find out the answer in full detail.
Medicare and Pre Existing Conditions
Medicare defines a pre-existing condition as any health condition or disability that was active before the start date of a new insurance plan.
If you’re enrolled in Original Medicare or Medicare Advantage (Plan C), you’ll be covered for pre-existing conditions. However, when you enroll matters greatly – see below for more information.
Some exceptions to pre-existing condition coverage applies to people enrolled in Medigap (Medicare Supplement). Additionally, Medigap may exclude people with end-stage renal diseases (ESRD) from coverage.
Medicare Special Needs Plan
A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage Plan offering additional benefits to people with special needs. One of the types of Special Needs Plans is the Chronic Condition SNP. You must qualify to enroll, but individuals with cancer (pre-existing or otherwise) qualify for the SNP.
If the Chronic Condition SNP is offered where you live, you can enroll at any time. Note that Medicare Special Needs Plans are not available in every state. If you live in a state without SNP coverage, your cancer should be covered by your Medicare Advantage or Medicare Original plans.
Enrolling at the Right Time
Private health insurance companies sell Medicare Supplement plans. These companies are allowed to use a process called medical underwriting when reviewing an application. Medical underwriting is when an individual’s medical history – including pre-existing conditions – is reviewed to determine their approval and policy fees.
Now, here is where a vital distinction comes into play.
Insurance companies cannot conduct medical underwriting during the Medicare Supplement Open Enrollment Period. The federal law states that you have six months to enroll in appropriate Medicare plans once you turn 65 and this period is known as the Medicare Supplement Open Enrollment Period. If you miss this period, you’ll have to wait for the annual Medicare Open Enrollment Period (Oct 15 – Dec 7) or the annual Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31).
However, if you miss the six-month Medicare Supplement Open Enrollment Period, insurance providers can now perform medical underwriting. This means they can use your cancer diagnosis to deny your application or raise your prices.
Ultimately, as Medicare is offered through private insurance companies, each policy can vary. It’s essential to get a clear understanding of a policy before you sign up with an insurance provider. Clarify:
- The different types of plans available to you
- The coverage you’ll receive (hospital stays, long-term care, etc.)
- If you’ll be approved with pre-existing cancer
- If you’ll be charged more for having cancer
- Any restrictions in your coverage. For example, many policies require cancer patients are denied coverage for the most revolutionary and new drugs available on the market and are only covered for the cheapest alternative.
It’s also essential to sign up as soon as possible. If you miss your Medicare Supplement Open Enrollment Period, you may have to wait for the next enrollment period to sign up for coverage. This could result in a gap in your coverage, leaving you with costly medical bills. Ensure you sign up on time, review all your options, and shop between several health care providers.