By Daniel Petkevich
Mar 28, 2023
Are you concerned about being denied coverage for pre-existing conditions under Medicare Advantage plans? You're not alone. Pre-existing conditions have been at the forefront of healthcare debates for many years now. Luckily, if you are interested in signing up for a Medicare Advantage plan, also known as Part C, you can join even if you have pre-existing conditions. But you should approach this decision with a degree of caution. Let’s talk through your options and why you might want to have some wariness when opting for Medicare Advantage plans with a pre-existing condition.
According to Medicare.gov
According to CMS.gov
Asthma
Diabetes
High blood pressure
Substance abuse and dependency
COPD
Organ failure
HIV
Arthritis
And many more
From the CMS article:
While insurers generally determine the presence of a pre-existing condition based on an applicant’s current health status, sometimes a healthy applicant can be deemed to have a pre-existing condition based on a past health problem or evidence of treatment for a particular condition.
Luckily in recent years, and especially with government-backed insurance programs like the ACA and Medicare, you should not face barriers when signing up due to your pre-existing conditions.
First, it’s important to understand the distinction between Original Medicare and Medicare Advantage plans. Medicare Advantage plans include Original Medicare (Part A hospital insurance and Part B medical insurance), and usually include a prescription drug plan (Part D). Medicare Advantage plans are sold by private insurers that, by law, need to provide at least the same level of coverage as Original Medicare.
You will not be denied a Medicare Advantage plan because you have a pre-existing condition.
Medicare Advantage plans are not inherently bad
The insurance providers of Medicare Advantage plans might be restrictive in offering coverage when it comes to seeking specific care for your pre-existing condition. When choosing a Medicare Advantage plan, you will choose between HMO and PPO. For a deep dive into the difference between HMO and PPO, check out our article here
An HMO plan means that you can only seek care in your network. Otherwise, you will pay the entire cost out-of-pocket. A PPO plan means you can seek care outside of your network and receive some coverage, but you will pay more to go outside your network.
For example, if you are signing up for a Medicare Advantage plan with a pre-existing condition like cancer, they cannot prevent you from joining that plan. But if your cancer worsens and you are interested in seeking treatment or a second opinion at a hospital outside of that Medicare Advantage plans network, you could face higher bills or potentially pay for the entire procedure or consultation out-of-pocket.
In some instances, your Medicare Advantage plan might require prior authorization. That means that your coverage only kicks in if you get certain types of treatment approved by your insurance plan provider. If you want one form of treatment for your condition, and your provider would rather you get another form of treatment, you might have to pay for the preferred treatment out-of-pocket.
Another way to add more coverage to your Original Medicare is through Medicare Supplement plans. These plans are sold by private insurance companies, but they are standardized by the government, so you might see different prices for the same levels of coverage. One of the key differences between Medicare Supplement and Medicare Advantage is that with a Supplement plan, you can seek treatment from any doctor who accepts Medicare, which includes over 90% of doctors nationwide. No fussing with HMO or PPO networks, just the Medicare network. However, if you’re trying to switch into a Medicare Supplement plan, it might get tricky.
Sometimes, insurance companies can dig through your medical history and increase your premium, delay your coverage, or sometimes even reject your application. While Original Medicare is not limited by pre-existing conditions, Medicare Supplement insurance plans have different rules.
Unfortunately, when joining Medicare Supplement plans outside your Initial Enrollment Period (three months before you become eligible for Medicare until three months after you are eligible) and certain Guaranteed Issue periods, insurance companies have the ability to scrutinize your medical history and may increase premiums, impose waiting periods for coverage, or even reject your application in some cases.
This scrutiny is called Medical Underwriting. As a result—you might have a tougher time getting coverage due to your pre-existing conditions. Medical Underwriting doesn’t necessarily mean that you won’t be allowed to join a given Medicare Supplement plan, but you might have to pay much more for that plan than you would have without it.
Medicare Advantage plans will not deny you from joining their plan, but you might face much steeper out-of-pocket costs if you try to go outside your HMO or PPO network. Medicare Supplement plan providers won’t deny your treatment based on network restrictions or prior approval, but if you are trying to switch from an Advantage plan to a Supplement plan, you could face Medical Underwriting, which makes joining a plan harder or more expensive.
The best way to avoid these pitfalls is to speak with a Medicare expert at Fair Square
Pre-existing conditions cannot prevent you from joining a Medicare Advantage plan. If you enroll for a Medicare Supplement plan when you are first eligible for it, pre-existing conditions cannot prevent you from joining the plan, and you won’t face as many hurdles when you seek treatment due to your condition. We know Medicare can be complicated, and that’s why we’re working to make it easier for everyone. Please give us a call at 888-376-2028 if you have any questions or are ready to sign up for Medicare.
Medigap vs. Medicare Advantage
May 25, 2020
Is Fair Square Medicare Legitimate?
Jul 27, 2023
Can I Change My Primary Care Provider with an Advantage Plan?
Aug 25, 2023
2025 Medicare Price Changes
Oct 30, 2023
Does Medicare Cover Lipoma Removal?
Dec 8, 2022
Can Medicare Advantage Plans be Used Out of State?
Jun 12, 2023
Does Medicare Cover TENS Units?
Nov 23, 2022
Does Medicare Cover Mouth Guards for Sleep Apnea?
Dec 8, 2022
Does Medicare Cover Stair Lifts?
Nov 18, 2022
What People Don't Realize About Medicare
Mar 27, 2023
Plan G vs. Plan N
Jan 28, 2022
Health Savings Accounts (HSAs) and Medicare
Jan 24, 2024
Does Medicare Cover Abortion Services?
Dec 13, 2022
Does Medicare Cover Orthodontic Care?
Nov 18, 2022
Does Medicare Pay for Varicose Vein Treatment?
Nov 18, 2022
Does Medicare Cover RSV Vaccines?
Sep 13, 2023
2024 Fair Square Client Retention and Satisfaction Report
Mar 4, 2025
Does Medicare Cover Light Therapy for Psoriasis?
Jan 17, 2023
13 Best Ways for Seniors to Stay Active in Columbus
13 Best Ways for Seniors to Stay Active in Indianapolis
13 Best Ways for Seniors to Stay Active in Philadelphia
14 Best Ways for Seniors to Stay Active in Seattle
14 Best Ways to Stay Active in Charlotte
15 Best Ways for Seniors to Stay Active in Denver
20 Questions to Ask Your Medicare Agent
Are Medicare Advantage Plans Bad?
Building the Future of Senior Healthcare
Can I Have Two Primary Care Physicians?
Can I Laminate My Medicare Card?
Can Medicare Help with the Cost of Tyrvaya?
Do All Hospitals Accept Medicare Advantage Plans?
Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?
Does Medicare Cover Air Purifiers?
Does Medicare Cover Bariatric Surgery?
Does Medicare Cover Boniva?
Does Medicare Cover Breast Implant Removal?
Does Medicare Cover Cala Trio?
Does Medicare Cover Cartiva Implants?
Does Medicare Cover Cervical Disc Replacement?
Does Medicare Cover Chiropractic Visits?
Does Medicare Cover Cold Laser Therapy (CLT)?
Does Medicare Cover Cosmetic Surgery?
Does Medicare cover Deviated Septum Surgery?
Does Medicare Cover ESRD Treatments?
Does Medicare Cover Flu Shots?
Does Medicare Cover Geri Chairs?
Does Medicare Cover Home Heart Monitors?
Does Medicare Cover Hypnotherapy?
Does Medicare Cover Iovera Treatment?
Does Medicare Cover Ketamine Infusion for Depression?
Does Medicare Cover Kidney Stone Removal?
Does Medicare Cover Kyphoplasty?
Does Medicare Cover Mental Health?
Does Medicare Cover Piqray?
Does Medicare Cover Robotic Surgery?
Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?
Does Medicare Cover SI Joint Fusion?
Does Medicare Cover the WATCHMAN Procedure?
Does Medicare Cover Tymlos?
Does Medicare Cover Wart Removal?
Does Medicare Have Limitations on Hospital Stays?
Does Medicare Pay for Allergy Shots?
Does Medicare Pay for Bunion Surgery?
Does Retiring at Age 62 Make Me Eligible for Medicare?
Does Your Medicare Plan Cover B12 Shots?
Explaining IRMAA on Medicare
How Does Medicare Pay for Emergency Room Visits?
How Does the End of the COVID-19 Public Health Emergency Affect Your Medicare?
How Much Does a Pacemaker Cost with Medicare?
How Much Does Trelegy Cost with Medicare?
How to Become a Medicare Agent
Is Displacement Affecting Your Medicare Coverage?
Is Emsella Covered by Medicare?
Is Gainswave Covered by Medicare?
Is the Shingles Vaccine Covered by Medicare?
Medicare Explained
Medicare Guaranteed Issue Rights by State
Seeing the Value in Fair Square
The Fair Square Bulletin: October 2023
Welcome to Fair Square's First Newsletter
What Happens to Unused Medicare Set-Aside Funds?
What Is a Medicare Advantage POS Plan?
What Is a Medicare Supplement SELECT Plan?
What Is Medical Underwriting for Medigap?
What Is the Medicare Birthday Rule in Nevada?
What To Do If Your Medicare Advantage Plan Is Discontinued
What's the Deal with Flex Cards?
What's the Difference Between HMO and PPO Plans?
Why You Should Keep Your Medigap Plan
Will Medicare Cover Dental Implants?
Get the Fair Square Bulletin
Medicare savings tips, helpful guides, and more.
Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
MULTIPLAN_FairSquareMedicare_01062022_M