I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?

Question

Don Hudson · Accepted Answer

If you have a severe or disabling condition that recently occurred and are enrolled in a Medicare Advantage plan you may qualify a (SEP) Special Enrollment Period.
If you have a Medigap plan most likely no changes will be needed.

Lt Col Tim Brown · Answer

That isn’t enough information for me to answer you. I don’t know what type of plan you have but either type should be sufficient. Give me more info on your plan and the change in your health for a more specific answer. Either type plan will perform as stated in the evidence of coverage.

Answered by Lt Col Tim Brown on April 26, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Gary Church · Answer

Your current health condition has no effect on your Medicare itself comes down to the Medicare advantage plan that you have. Does it allow you to see the doctors and specialist that you wanna see 
In network.

Melonie Wood · Answer

on Medicare Advantage Plans there is NO underwriting, so regardless of the health of someone, everyone can get a Medicare Advantage Plan is long is their Part A & B are in effect. Medicare Supplements require medical under writing and based on results could require much higher monthly premiums

Answered by Melonie Wood on March 30, 2025

Agent Licensed in FL & AL

Answered by Melonie Wood Medicare Insurance Agent

Nikki Rowland · Answer

It is always a GREAT idea to review your coverage. Plans change and as you know, how health care needs change. There may or may not be something better for you. I always encourage plan reviews.

Joseph Bachmeier · Answer

In most cases you do not need to worry as much if you have a Medigap plan. The change in your health could affect your medical costs under a Medicare Advantage plan or your Part D drug plan.

Richard Moreno · Answer

Your health change could trigger a change of coverage. It depends on what those health changes are. Some Medicare advantage plans are specific to chronic diseases and can offer certain benefits that are tailored to the kind of healthcare you may need. If you have original Medicare with a Medicare Supplement. Than it’s highly recommended to stay with that, especially if you have had drastic changes in your health and are needing more visits to doctors and specialists. Same goes with hospitalization and rehab or skilled nursing facilities. It’s best to stay on original medicare

Answered by Richard Moreno on July 30, 2025

Broker Licensed in TX, FL, LA, NM & OH

Answered by Richard Moreno Medicare Insurance Agent

Sandra Teel · Answer

Good Question.  Health changes happen as we get older.  How your health change can affect your Medicare plan will depend upon the type of Medicare plan you have.  For instance:

1) If you have a Medicare Advantage plan, it would be wise to take a look at your plan in the Annual Enrollment Period (Oct 15- Dec 7th) to see if there is another Medicare Advantage plan that will cover your health condition better.  Some Medicare Advantage plans have "Chronic" condition plans that would help with certain chronic conditions like diabetes, and heart disease.
If you have a qualifying chronic condition, you might be able to make a change to the new plan sooner that the Annual Enrollment period. Be sure to call a Medicare Insurance Broker to find out if you qualify to make a change.


2) If you have a Medicare Supplemental Plan (Metsup) then you do not have to make any changes. You can choose to see any Medicare specialist doctor for your health condition.


If you are confused, please be sure to reach out and get help from a Medicare Insurance professional that works with both types of plans.

Justin Call · Answer

You should absolutely reconsider your coverage. That doesn't necessarily mean you will change it, but we need to explore options before it's potentially too late. Sometimes there are only certain windows to make changes and we don't want to get outside any of those windows.

Answered by Justin Call on June 30, 2025

Broker Licensed in UT, ID, MT & WY

Answered by Justin Call Medicare Insurance Agent

Justin Doherty · Answer

Your health should not change your Medicare plan. However, you should review your plan options to make sure your plan will adequately cover the health needs of your new condition.

Melissa Foster · Answer

I always advise my clients to do an annual review but with a new condition you may want to do a benefit review early. Due to your new condition you might qualify for a SEP, but if you don’t qualify be ready for the Medicare annual enrollment October 15th through the December 7th.

Answered by Melissa Foster on June 30, 2025

Broker Licensed in OK, KS, NM & TX

Answered by Melissa Foster Medicare Insurance Agent

Steven Lovell · Answer

Regardless of your current plan, health conditions shouldn't affect it or how it pays your bills at all. If you feel like you want additional coverage you may want to contact someone like myself to review your situation and see if you can change plans but it's not necessary due to a change in your current health situation.

Answered by Steven Lovell on May 27, 2025

Broker Licensed in GA, CA, FL & 7 other states

Answered by Steven Lovell Medicare Insurance Agent

Michael Yost · Answer

During the annual enrollment period, AEP, (10/15 - 12/7), it's always good to review your coverage. Your health may change, medications may change, and Medicare plan options may change. However, if your health changed prior to AEP, you may be eligible to change or update your plan sooner.

Answered by Michael Yost on May 12, 2025

Broker Licensed in OH, AL, AZ & 27 other states

Answered by Michael Yost Medicare Insurance Agent

Ron Cronwell · Answer

Usually a change in medical health condition does not impact your plan. The exception might be chronic kidney failure or ALS. 

In terms of reconsideration of your plan, each year, in the fall, people with Medicare Advantage plans are able to compare plans and make changes if they wish.

Contact your local agent and discus the changes to determine how your plan covers your new situation.

Tammy Stoner · Answer

Depending on the plan, time of year, and the health condition it could possible to change plans. 
My expertise can help you make the right decision for your continued health care. 

If you are turning 65 or this is your first time on Medicare part B, it is imperative that you speak with a licensed agent to help you make the right decision regarding your health coverage.

Betty McCarty · Answer

Your Medicare plan could be greatly affected by your health. There are specialized plans tailored to chronic conditions in certain counties that are greatly beneficial. 

A Chronic Condition Special Needs Plan is a Medicare Advantage plan designed for people who have a chronic or disabling condition.

Benefits of a C-SNP can include specialized care, transportation, meal delivery services, access to specialists, telehealth services, and more.

If you need help signing up for a C-SNP, a Medicare Advisor can assist. Call us at 509-216-3069 or schedule a time to chat. 

So, whether your health condition has improved or declined, an Advisor can help you understand your options better, even if you already have a C-SNP.

Aisha Saleem · Answer

A change in your health condition could affect which Medicare plan is best for you at the present time. Significant life events can cause your health needs and life circumstances to be better served with a particular plan. You should check the plan you already have and compare it to new options. An agent can help you decide if it would be better for you to pick a new plan. You can enroll in a new plan or update your existing coverage.

Answered by Aisha Saleem on June 1, 2025

Agent Licensed in MD & FL

Answered by Aisha Saleem Medicare Insurance Agent

Sophia Davis · Answer

Having a change in your health status is always a great reason to take a closer look at your coverage. It may or may not be necessary, but it's always worth a look.

Debra Weber · Answer

Your insurance cannot cancel your policy because of your health. Nor can they raise your premiums because you use the policy more. It would only make a difference if you were to try to change a Medicare Supplement. They could tell you no due to healrh questions . I hope that answered your questions

Answered by Debra Weber on March 26, 2025

Broker Licensed in PA, DE, FL & 5 other states

Answered by Debra Weber Medicare Insurance Agent

Donald Baker · Answer

That depends on the insurance plan you currently have. It also might depend on your new medical condition.

Dashelle Warntjes · Answer

I believe it is always helpful to advocate for yourself, by reaching out to a licensed professional like myself to reevaluate your current coverage when health conditions change!

I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?

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I've had a change in my health condition. How does this affect my current Medicare plan, and should I reconsider my coverage?

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