Does Medicare Cover Pre-Existing Conditions?
- July 26, 2022
- Reviewed by John Krahnert
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 where you live
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.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
