Medicare is health insurance that is offered by the federal government for the people of 65 or more years. It provides them coverage for their healthcare needs; however; it does not cover all of Medicare supplement planstheir healthcare expenses. The out-of-pocket expenses which are not covered under Medicare are covered by separate plans that are referred to as Medicare Supplement Plans or Medigap. These plans cover out-of-pocket expenses, i.e. coinsurance, copayment, and deductibles. Medigap is considered as an add-on or supplement to Original Medicare as it fills the gap between the coverage of Original Medicare and your actual healthcare needs. If you have any pre-existing condition before applying a Medicare supplement insurance plan, then it may contain the hazard of being denied by the Medicare supplement plan. So, before applying for a Medicare supplement insurance plan, it is important to know the following questions:

  • What do you mean by pre-existing conditions?
  • How may these pre-existing conditions affect your capacity to get coverage for out-of-pocket expenses?
  • When should you apply for Medigap policy if you have a pre-existing condition?
  • Will your Medigap plan admit your pre-existing condition?
  • Will the insurance company charge more for the Medigap plan for such conditions?
  • Will these conditions be covered under the Medicare supplement insurance plan?


Can You Be Denied Medicare Supplement Insurance?

While considering buying a Medicare supplement insurance plan, you have to know your capacity to get coverage due to pre-existing conditions. Can your Medicare supplement insurance deny your coverage? The answer to this question depends on your understanding of pre-existing conditions, the time period to apply for Medicare supplement plans, the premium charged for Medigap plan due to pre-existing conditions and pre-existing waiting time period. Once in awhile insurance companies accept your coverage even if you have any pre-existing condition. Conversely, sometimes your Medicare supplement insurance may deny your coverage or charge you more for your healthcare coverage.


What Do You Mean by Pre-existing Condition?

Pre-existing condition refers to any condition and illness that you have before applying and receiving coverage for your healthcare needs including different types of ailment or injuries, i.e. cancer, heart ailment, asthma, pain, high blood pressure, diabetes, swelling, and many more. These conditions are publically very common in most people. Research reveals that almost 50-70% of people among the 55-65 years older people have any pre-existing condition. Moreover, these conditions have a tendency to be prolonged and enduring.


Enrollment time periods for Medicare Supplement Insurance Plan:

There are different times available for the enrollment of Medicare supplement plans, i.e. open enrollment and after open enrollment. The enrollment time for Medicare supplement insurance has a strong impact on exactly how your coverage works.

  •      Open Enrollment:

Open enrollment is considered as the best time period to get enrollment for a Medicare supplement insurance plan. This time period starts when your age turns 65 years, and you sign up for Medicare Part B. The open enrollment time period remains tills six months after your 65 birthday. During the six months open enrollment time period, insurance companies cannot deny or refuse your coverage or charge you more for any pre-existing condition. The enrollment in a Medicare supplement insurance plan will alleviate the hazard of being dropped for pre-existing coverage.

  •      After Open Enrollment:

You can also sign up for a Medicare supplement insurance plan once the open enrollment time comes to an end. When you apply enrollment for Medigap plans after the open enrollment, an insurance company has an obligation to provide you coverage for pre-existing conditions only if you have a guaranteed right issue also referred to as Medigap protection. If you do not have a guaranteed right issue, then the insurance company may deny your coverage or charge you more for your pre-existing condition.

You would be eligible for guaranteed right issue for Medicare supplement plans in certain situations:


  • Your Medicare supplement insurance may mislead and deceive you. Need help? Get quotes by visiting
  • Your Medigap plan may involve any fraud or expired as bankrupt.
  • You drop or release your Medigap plan for a one year trial of Medicare Advantage Plan, and now you want to switch back to your Medigap plan.
  • Your Medicare Advantage Plan is not properly working in your area.
  • You change your location from a location covered under Medicare Advantage Plan.


Pre-existing Waiting Period:

Although you can sign up for Medigap plan if there is a lack of guaranteed issue right while applying for Medicare supplement plans. However, you have to wait for covering your pre-existing condition. This waiting time is referred to as a pre-existing waiting period. This time period continues for six months and only applies to your health condition that you have before the start of your Medigap plan. You can avoid the pre-existing waiting period in two situations, i.e. guaranteed right issue and open enrollment. When you apply for Medicare supplement insurance during these situations, an insurance company can’t impose a pre-existing waiting period for your coverage under pre-existing conditions.



Why is Open Enrollment Time best?

The open enrollment time period is considered as best and important as, during this time period, medical underwriting is not used by insurance companies to offer you Medicare supplement insurance plans and coverage for your pre-existing healthcare condition. Medical underwriting means that the insurance companies take information for your healthcare condition or health history to evaluate your application for a Medigap plan. Moreover considering health history and its coverage costs insurance companies may deny your coverage due to pre-existing conditions. During the open enrollment period, you can easily apply for Medicare supplement plans and your coverage would be guaranteed.


Other considerations:

There are some other situations under which an insurance company can deny your Medicare supplement insurance and not sell you a Medigap plan if:

  • You do not have enrollment in Medicare Part A.
  • You do not sign up in Medicare Part B.
  • You already enrolled in the Medicare Advantage Plan.
  • You have a Medicaid plan.


Bottom Line:

An insurance company cannot deny or refuse your coverage for Medicare supplement insurance or charge you more for your covering any of your health conditions that you already have before receiving your Medigap plan if you get enrollment in Medicare supplement plans during the open enrollment period. Conversely, if you apply for enrollment in Medicare supplement insurance after open enrollment (with the exception of guaranteed right issue), your coverage can be denied by the insurance company. Nonetheless, when you have a Medigap plan, the insurance company has an obligation to renew it regardless of any healthcare issue that you have.

A Medicare Advantage Plan for Seniors

A Medicare Advantage Plan for Seniors

As an older person you probably know, there are certain alternatives to Original Medicare to select from and Medicare advantage plans is one of them. Today, many older people choose to go for a benefit plan of Medicare, as they are going to have more insurance and extra benefits in addition to direct costs. However, you will have difficulty deciding which insurer or what level of coverage to choose if you have not done your research. Irrespective of whether you are worried because of your medical costs in the future or what is happening now, knowing the benefit policies to replace Medicare will be a great idea.

Who sponsors Medicare Advantage plans?

Medicare Advantage Plans – Cost

You may have noticed that Medicare and a complementary policy costs far more than any Medicare policy available. For instance, there are several Medicare benefit policies that are literally completely free for all seniors who have already enrolled in Medicare Part B. In general, you will have to pay the Part B premium. These copays and deductibles will still exist depending on of the completion of your health plan.

If you want to find the best Medicare plan for your individual needs, feel free to compare the benefits and contributions of the plan during your open enrollment period in Medicare.

Medicare Advantage policies provide better quality of medical care

Now, according to research conducted by Niall Brennan, interim director of the Policy Office of the Centers for Medicare and Medicaid Services, also Mark Shepard, who is a candidate for a doctorate in economics at Harvard University, Medicare Advantage policies address superior quality Compared to Medicare, hospital use and health care policies are applied with widely accepted quality measures.

In 2006, when initial data on the Medicare Advantage policy were available, Shepard and Brennan made 11 measurements to analyze the misuse of effective treatment. Of the 11 measurements, Medicare Advantage plans outperformed service charge plans in 9 service charge plans. Payment-for-service plans exceeded Medicare Advantage plans only for some measures that were not so important for general care.While it is generally a good idea to ask friends and family for recommendations, keep in mind that medical needs are very individual and that a perfect short-term Humana health insurance plan for them may not meet your health care needs. To make the right decision, you must also know the differences between Medicare Advantage plans and Medicare supplement insurance. There is no size for everyone.

What Are The Different Medicare Benefit Plans?

What Are The Different Medicare Benefit Plans?

Medicare Advantage plans are health insurance options for people with Medicare. This includes Medicare-managed care plans, such as Medicare Health Maintenance Organizations (HMO) and Preferred Provider Organizations (OPP). The most recent option is the Private Service Rate Plans (PFFS). Each year, Medicare staff can choose from the Medicare Advantage Plan options available in their area. Regardless of the Medicare benefit plan that a person chooses for coverage, they will continue to pay the Part B premium. It is important to understand how the different Medicare benefit plans work. The descriptions below will provide a brief description of these plans. These options vary by state and county in their availability.

Health Maintenance Organizations (HMOs): Medicare HMOs offer services through a network of hospitals, doctors and other service providers. People with Medicare who choose to participate in an HMO must receive all of their non-emergency Medicare services from the HMO provider network. In general, health plans have small copies for covered medical services. The HMO often uses the primary care physician as a “janitor” to control medical costs and requires referrals to specialized medical services.

Preferred Provider Organizations (OPP): Medicare PPO is similar to an HMO in the sense that PPO has a network of medical providers contracted with the insurance company to provide medical services to people eligible for Medicare. However, PPOs generally do not require the referral of primary care physicians to specialized medical services.

Similar to the action plan, the PPO has health care records received from providers in the PPO network. However, the PPO generally has higher out-of-pocket expenses for medical services received outside the network of medical providers.

Private Service Charge (PFFS): Private companies offer Medicare PFF plans to provide health care coverage to people with Medicare with a service payment contract. Insurance companies may decide that a plan will be available to all people with Medicare in one state or open only in certain municipalities. In addition, the PFFS plan may also offer additional health benefits. This may include prescription drug benefits, vision, hearing, wellness programs, etc.

With a PFFS plan, you can go to any Medicare advantage -approved doctor or hospital that is willing to help and accept your plan’s payment terms and can get services outside of your service area, but at a higher cost. You The insurance company, instead of the Medicare program, decides how much you pay for the services you receive. Although the amount you pay for these services may not be the same as your original Medicare plan, you get all the services covered by Part A and Part B.

What are Medicare HMO plans?

What are Medicare HMO plans?

Medicare itself is not an HMO or PPO or any other type of network. Original Medicare, which is now what is commonly known as Medicare, is accepted or not by a doctor. By accepting Medicare, the doctor agrees to accept what Medicare pays for a particular procedure/visit. The doctor can also accept or not Medicare, which is a totally different topic.

What are Medicare HMO plans?

The Medicare HMO plans will be Medicare Advantage plans or Medicare Part C plans. These plans are completely different from Original Medicare. When joining a Medicare HMO plan, you should know the network of doctors and centers with which the HMO plan is contracted. If you find a provider outside the HMO network, HMO insurance will not pay the bill. With Medicare HMO plans, you must stay in the network all the time, except for emergency and urgent care when you travel. Medicare HMO plans also require a referral in most cases to see a specialist. There are some exceptions to this rule, but not many. Finally, these plans generally also require permits for more expensive brand procedures and medications. On the positive side, you will find that you generally save money on premiums and co-participate when you are in a Medicare HMO plan, which is why many Medicare beneficiaries find them so attractive.

Is a Medicare HMO plan right for you?

Everyone has different needs and wants when it comes to health insurance coverage. The first thing to keep in mind is how attached you are to your doctor. If you have a primary care doctor who will not leave, you should make sure you are in the HMO network. If you find multiple experts, the same applies. Also, consider how willing you are to deal with WMO that requires referrals and permits. Keep in mind that most specialists will require a referral, even if insurance does not require it.

And finally consider the cost. Often, the HMO will be considerably cheaper for more expensive procedures. Hospital stays, MRI and outpatient surgery are some of the typical areas where you can save a lot of money with an HMO. Also, keep in mind that not all health plans are the same. Some HMOs offer better networks than others and make faster payments to doctors. Some examples of companies that offer HMOs are Humana, United Healthcare, Wellcare and Healthspring.