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pre-existing condition

What is a pre-existing condition?

What is a pre-existing condition?

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

Footnotes
  1. ”Medicare & You 2025” Medicare.gov. And “Can I be charged a higher premium for Medicare Part D plans if I have a pre-existing condition or if I smoke?” KFF.org. Accessed May 21, 2025 ⤶
  2. ”Medigaps and prior medical conditions” Medicare Interactive. Mar. 31, 2025 ⤶

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