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, which includes many pre-existing conditions.
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Medicare Advantage plans 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
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.
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.
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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.
Original Medicare (Parts A and B) doesn’t cover routine dental or vision care. 2024 Medicare Advantage (Part C) plans can cover benefits Original Medicare doesn’t cover, but dental and/or hearing benefits may not be available where you live. Learn more and find out how to compare the plans and benefits available in your area.
Medicare Part B may cover emergency ambulance services, and some Medicare Advantage plans may offer non-emergency transportation to plan-approved locations. Learn more about Medicare transportation coverage.
Medicare Advantage plans can offer gym memberships and fitness benefits that Original Medicare doesn’t cover, such as SilverSneakers. Learn how to compare your local plan options and how to find a Medicare Advantage plan that covers fitness benefits.
While Original Medicare (Parts A and B) doesn’t cover hearing aids, Medicare Advantage (Part C) plans can cover hearing benefits Original Medicare doesn’t cover. Hearing benefits may be available where you live, so learn how to find out if Medicare Advantage plans that help pay for hearing aids are available in your area.
Medicare Part B covers annual wellness visits. Medicare Advantage plans also cover annual wellness visits, and many Medicare Advantage plans also offer other wellness benefits not found in Original Medicare.
Medicare Part A does not cover outpatient surgery, but Part B covers medically necessary outpatient surgery. Medicare Advantage plans may also cover outpatient surgery and include an annual out-of-pocket spending limit, which Original Medicare doesn’t offer.
Original Medicare and Medicare Advantage plans can cover chiropractic care, but some plans may cover services more than others. Learn about what’s covered, what’s excluded and how much your Medicare costs could be.
Medicare covers many telehealth services, and those benefits expanded during the coronavirus pandemic. Beneficiaries can use telehealth to access their doctor while also staying safe during COVID-19.
Original Medicare (Medicare Parts A and B) doesn’t cover bathroom grab bars or other bathroom safety devices. Medicare Advantage plans can cover bathroom safety devices, but only in limited situations and only for beneficiaries who qualify.
Original Medicare covers some limited home health services. Medicare Advantage plans cover the same home health care services and may include some additional benefits.
Join our email series to receive your Medicare guide and the latest information about Medicare.
By clicking "Sign me up!” you are agreeing to receive emails from MedicareAdvantage.com.
Thanks for signing up for our emails!
Your Medicare guide will arrive in your email inbox shortly. You can also look forward to informative email updates about Medicare and Medicare Advantage.
If you'd like to speak with an agent right away, we're standing by for that as well. Give us a call!