Coverage

Does Medicare Cover Pre-Existing Conditions?

Medicare typically covers pre-existing conditions in most cases. Learn more about how your Medicare benefits can cover your health care needs and chronic conditions.

Original Medicare (Part A and Part B) typically covers pre-existing conditions in most cases. You may be also be able to enroll in a Medicare Advantage policy (Medicare Part C) if you have a pre-existing condition, including end-stage renal disease (ESRD).

Medicare Advantage plans are sold by private insurers and combine Original Medicare (Medicare Part A and Part B) benefits into one single plan.

Every Medicare Advantage plan must provide the same hospital and medical benefits as Original Medicare, and Medicare Advantage plans cover most pre-existing conditions.

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End-Stage Renal Disease and Medicare Advantage

Medicare Advantage were not previously available to people with ESRD, but they are now. If you enroll in a Medicare Advantage plan that has a network of preferred providers (such as an HMO plan or a PPO plan), you should ensure that your dialysis facility and nephrologist are part of the plan network.

You may also be eligible to enroll in a Medicare Special Needs Plan (SNP) if you have ESRD or kidney failure, as well as if you have other types of pre-existing conditions.

Medicare Special Needs Plans can cover chronic conditions

A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan that is limited to people with specific diseases or conditions.

You may be eligible for a Medicare SNP if you have one or more of the following pre-existing conditions:

  • Chronic alcoholism
  • HIV/AIDS
  • Cancer
  • Drug addiction
  • Autoimmune disorder
  • ESRD requiring kidney dialysis
  • Diabetes
  • Chronic heart failure
  • Chronic lung disorder
  • End-stage liver disease
  • Disorder of the cardiovascular system

Important: All Medicare SNPs must provide Medicare prescription drug coverage, and most require you to stay within your SNP network for care.

Some Medicare SNPs may offer coverage for additional benefits such as hearing, vision and dental care.

Beneficiaries with chronic conditions have better outcomes with Medicare Advantage plans

A 2018 study found that people who have chronic health conditions experienced 23 percent fewer inpatient hospital stays as a member of a Medicare Advantage plan, compared to Original Medicare beneficiaries.

Medicare Advantage plan beneficiaries also experienced close to 33 percent fewer emergency room visits that beneficiaries of Original Medicare.

For someone with a pre-existing condition, enrolling in a Medicare Advantage plan could potentially lead to better health outcomes than sticking with Original Medicare.

Find a Medicare Advantage plan that covers your condition

If you qualify for Medicare and have a pre-existing condition, call today and speak with a licensed insurance agent to learn more about your options.

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