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Pre-existing conditions: Do they matter?

Dear Colleague,

Confusion continues years after the Affordable Care Act eliminated the practice of pre-existing conditions being considered in approving individual insurance applications. Since 2014, insurers have not been allowed to ask questions about one’s health when applying for individual insurance. And pre-existing conditions were never an issue affecting eligibility or cost for group coverage through an employer or union or Medicare. Watch our video on pre-existing conditions at healthcarenavigation.com/videos.

Pre-existing conditions continue to be a factor with Medicare supplements. Medicare supplements are private insurance products which supplement original Medicare. All Medicare supplements are guaranteed issue policies during the six-month period following one’s Medicare Part B effective date. After that six-month period, however, in most states, Medicare supplement insurers can consider pre-existing conditions during the application process and deny an applicant based on pre-existing conditions. For example, if an individual on a Medicare Advantage Plan, an alternative to original Medicare, decides to return to original Medicare, they may not be able to buy a private Medicare supplement depending on their health status if they are beyond the six month period following their Medicare Part B effective date. New York, Connecticut, Massachusetts and Maine have more consumer protections than the other 46 states. But, again, in most states insurers are allowed to reject applications based on pre-existing conditions if the application is submitted six months after one’s Medicare Part B effective date.

Pre-existing conditions also are relevant for other types of insurance products like individual disability, long term care coverage, short-term, and travel coverage.

One always has to follow enrollment rules when applying for coverage of any sort but this typically involves adhering to the timeframe or window within which coverage can be obtained or changed. Remember, coverage will always come with rules. Enrollment rules are intended to encourage people to maintain coverage and spread risk and thus discourage people from only obtaining coverage when they are sick and expect to use services.

Please watch the video and share this information with family and friends. Thanks.