Medicare and Pre-existing Conditions Lose Leverage In Markets

They take a backseat as the DOJ brief recommends ditching protection against discrimination.

In another move in the government’s seeming crusade to eat away at Americans’ access to affordable healthcare, the Department of Justice recently filed a brief supporting Texas and 19 other states in their desire to remove all protections for people with Medicare and pre-existing conditions under the Affordable Care Act (ACA).

Protection means that insurers cannot refuse a patient because of an illness or condition that existed before the patient applied for insurance. They also cannot charge more money, as some used to do, if they do issue insurance coverage for people with Medicare and pre-existing conditions.

Without protection, all sorts of bad things could ensue: ill patients could be without coverage, rates could go sky high or limits on lifetime coverage could be invoked.

So, how does Medicare stand on this? If you are a Medicare beneficiary, how does this affect you?

Medicare and pre-existing conditions

As of yet, Medicare does not discriminate in any way against people on Medicare and pre-existing conditions – for people eligible for Medicare coverage because of age. However, for those under 65 who need to receive a Social Security disability benefit, there is a two-year waiting period for coverage.

Medigap and pre-existing conditions

The best way to prevent any coverage issues with Medigap is to sign up during the open enrollment period when you are first eligible. During this time, you have “guaranteed issue rights,” meaning you cannot be denied coverage for a pre-existing condition.

However, your coverage for that condition may be delayed for six months. You will be covered for other services but not for ones related to the pre-existing condition.

Guaranteed Issue Rights

You also have guaranteed issue rights if you apply for Medigap within 63 days of the time when any previous coverage ends. Also, if you have a waiting time when you sign up for Medigap during open enrollment and you have had prior “creditable coverage,” your time can be reduced by one month for each month of enrollment in prior coverage – assuming you are within the 63-day period.

If you are about to sign up for Medigap, investigate the different policies, as some may have different regulations for pre-existing waiting periods.

Doctors against loss of protection

The American Medical Association (AMA) meeting last week discussed a lobbying campaign focused on keeping and supporting the Affordable Care Act. They are against the DOJ’s brief to end protections for pre-existing conditions.

Separately, doctor groups across the U.S. are urging that the DOJ rethink its position allowing discriminatory insurance coverage and pricing. They are concerned that millions of people will be left without adequate coverage or will face increased rates if they do receive coverage.

Again, so far Medicare isn’t touched by this DOJ decision, but with the government looking for places to pare down growing Medicare costs, coverage for pre-existing conditions would be low-hanging fruit.


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