[Podcast] Medicare: What to know about Medicare and pre-existing conditions - Medicare Simplified

In this episode of Medicare Simplified, we review pre-existing conditions when it comes to Medicare.




Mick Garry (host): Welcome to Medicare Simplified, a podcast by Sanford Health Plan, where our goal is to help you make the most of your Medicare Advantage benefits. I'm your host Mick Garry. A topic often at the top of the list when talking insurance is pre-existing conditions. Here to help us break down what you need to know about Medicare and pre-existing conditions is Jack Arnett, a manager at Sanford Health Plan. To start with the basics, Jack, what classifies as a preexisting condition?

Jack Arnett (guest): Thanks Mick, and good to see you again. It's been a while. Pleasure to be here. In general health insurance terms, pre-existing conditions, by definition, is having any sort of diagnosed health conditions prior to applying for coverage. And the key word there is diagnosed. We’re not talking about what my wife thinks I have, or what my uncle's best friend's neighbor thinks I have. We’re talking about a clinical diagnosis of a health condition. And these can range from relatively minor issues to, of course, major significant issues like cancer and congestive heart failure.

Mick Garry (host): Does Medicare take these conditions into consideration?

Jack Arnett (guest): Pre-existing conditions or previous health conditions do not affect a person's Medicare eligibility and coverage. Original Medicare parts A and B are available to any individual who is 65 and above, or younger than 65 and disabled -- or any age individual with end-stage renal disease regardless of health conditions.

Mick Garry (host): Do Part C plans vary when it comes to pre-existing conditions?

Jack Arnett (guest): Part C or Medicare Advantage plans, by rule -- or CMS, the Centers for Medicaid Medicare directive -- do not vary when it comes to pre-existing conditions. A health insurance carrier like us, Sanford Health Plan, cannot and will not ask for any health-related questions during the application process. The question my team gets quite a bit is ‘Do I qualify for a Medicare Advantage plan because of my health?’ It's a very common question. When it comes to Medicare Advantage plans, the simple answer is that we don't ask health questions. And this gives those potential enrollees great peace of mind knowing that they don't have to qualify health-wise for a Medicare advantage plan.

Mick Garry (host): Now that we know about Medicare and pre-existing conditions, what should our listeners do?

Jack Arnett (guest): Well, I think most Medicare beneficiaries should come away with this having peace of mind knowing that any prior health condition, any pre-existing health condition, will not disqualify them from enrolling into a Medicare Advantage plan or a standalone Part D plan. They can shop, they can review, they can, take a look at all plans available with that piece of mind, knowing that whatever their health situation is, it will not have a negative impact on their enrollment.

Mick Garry (host): Thank you, Jack, for helping us sort out the basics of Medicare and preexisting conditions. If you'd like to learn more about Medicare Advantage plan options from Sanford Health Plan, visit align.sanfordhealthplan.com or find more information in our episode show notes.


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