What is a pre-existing condition?

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How are Medicare benefits changing for 2026?

Changes to 2025 Medicare coverage include a $2,000 cap on Part D out-of-pocket costs, small reductions in the average premium for Medicare Advantage and Part D plans, increases for Medicare Part B and Part A premiums and cost-sharing, and adjustments to income-related premium surcharges for Part B and Part D.

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What is Medicare? History of Medicare Medicare and the ACA

A pre-existing condition is a medical condition that a person had before enrolling in a health plan.

Will a pre-existing condition prevent me from getting coverage?

In most cases, a pre-existing condition will not prevent you from getting Medicare coverage. Original Medicare, Medicare Advantage, and Medicare Part D prescription plans do not use medical underwriting. So pre-existing conditions are covered and will not be an obstacle to obtaining coverage under those plans.¹

But Medigap plans can exclude pre-existing conditions for up to six months, if the person didn’t have creditable prior coverage before enrolling in the Medigap plan. And if a person applies for a Medigap plan outside of their initial enrollment period or a guaranteed-issue special enrollment period, the insurer can consider pre-existing medical conditions. This means they can either reject the application or charge a higher premium based on the applicant’s medical history.²

My wife is retiring and I’m losing the coverage I had through her employer. What are my options until I’m eligible for Medicare?

Depending on where you live, you may have several coverage options until you're eligible for Medicare, including COBRA or state continuation, a privately purchased Affordable Care Act-compliant plan, or a lower-cost plan that doesn’t have to follow the ACA’s rules, such as a short-term medical (STM) policy.

What is Medigap? Your guide to Medicare supplement insurance

Medicare supplement insurance, or Medigap, is insurance that supplements Original Medicare, covering some or all of the out-of-pocket costs that a beneficiary would otherwise have to pay for services covered by Original Medicare.

pre-existing condition