A pre-existing condition is a health problem you have before the new insurance policy plan starts. What are Medicare Supplement plans pre-existing conditions? It depends on the time of enrollment in the Medicare Supplement (Medigap) plan. Consider three different scenarios: Medicare Supplement Open Enrollment Period, Guaranteed Issue Right, and Medical Underwriting.
Medicare Supplement plans Pre-existing Conditions – Open Enrollment Period
The best time to enroll in a Medigap plan is during the Medicare Supplement Open Enrollment Period – six month period after you’ve enrolled in Medicare Part B. During this period an insurance company cannot use medical underwriting:
- They cannot refuse to sell you a Medicare Supplement plan
- They cannot charge you more due to existing health problems
- They cannot make you wait for coverage to start
The company cannot make you wait for your coverage, but they may make you wait for coverage related to a pre-existing condition. The company may use the pre-existing condition waiting period that cannot exceed 6 months. After 6 months, the Medicare Supplement plan must cover any pre-existing condition. The company may use a waiting period ONLY if the condition was treated or diagnosed within 6 months before the Medigap coverage starts.
Under some circumstances, you may avoid or shorten the waiting period. The insurance company cannot make you wait for pre-existing condition coverage:
- If you had at least 6 months of continuous previous insurance coverage that can be counted as a “creditable coverage,” and
- If you didn’t have a break in coverage for more than 63 days
Medicare Supplement plans Pre-existing Conditions – Guaranteed Issue Rights
In certain situations, known as Guaranteed Issue Rights, you are entitled by law to buy a Medigap policy without medical underwriting, i.e., without having to answer any health questions.
If you are entitled to Guaranteed Issue Rights, the insurance company:
- Cannot refuse to sell you a Medicare Supplement plan
- Cannot charge you more due to existing health problems
- Cannot place conditions on your Medigap policy
The pre-existing condition constraint is also not available; there is NO waiting period for coverage of pre-existing conditions.
Medicare Supplement plans Pre-existing Conditions – Medical Underwriting
If you are applying for a Medicare Supplement policy after your Open Enrollment Period and do not have Guaranteed Issue Rights, the insurance company is allowed to use medical underwriting to decide whether to accept your application, to charge more for the plan, or to impose its regular (up to six months) pre-existing conditions waiting period.
If you switch from one Medigap policy to another Medigap policy with the same benefits, the insurance company cannot exclude your preexisting conditions if you had 6 months or more coverage with the previous company. But if the new policy has a benefit that is NOT in your current Medigap policy, then you may wait up to 6 months before that benefit will be covered, regardless of how long you had your current policy.
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For help finding whether you have Pre-existing Conditions for Medicare Supplement, please contact Liberty Medicare or call us at 877-657-7477.
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