Pre Existing Conditions and Medicare Supplements


Do Medigap Plans cover pre existing conditions?

Many people think that “Obamacare” or the Affordable Care Act did away with all pre existing condition exclusions. And yes, for folks under 65 purchasing individual qualified health plans, there are no longer any health questions or pre existing condition clauses. However, this does not impact Medicare, or Medicare Supplement Plans. Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Supplement Plans are insurance plans purchased through private insurance companies to fill in the “gaps” in Parts A and B, and pay the out of pocket costs that Original Medicare doesn’t pay. Medicare Supplement Plans are medically underwritten, meaning the insurance company can ask you a series of health questions to determine if you qualify. Depending on your health, or your height and weight, they could charge you a higher premium, or deny you coverage all together. However, when you’re first getting on to Medicare you have a “Medicare Supplement Open Enrollment Period” – this is a time when you can get any Medigap Plan you’d like, with any company and you are guaranteed to be issued that policy and they can’t charge you a higher rate. This open enrollment period lasts up to 6 months after turning 65 or adding Medicare Part B, and it’s really the best time to buy a Medigap Plan since you are guaranteed to be issued any plan you’d like. It’s a common misconception that folks think that the Medigap open enrollment period is an annual thing, that every year they can switch their Medigap Plan if they want, with no health questions. But it the majority of states, that is not correct. After you’re initial Medicare Supplement Open enrollment period, you will have to answer health questions in order to qualify for a new or different medicare supplement plan. The Medicare Annual Election Period only applies to Part D Rx plans and Medicare Advantage Plans.

What about pre existing condition waiting periods?

This is directly from the 2017 CMS Guide to Choosing a Medigap policy:

“While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre-existing condition. A pre-existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is called a “pre-existing condition waiting period.” After 6 months, the Medigap policy will cover the pre-existing condition. Coverage for a pre-existing condition can only be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. This is called the “look-back period.” Remember, for Medicare covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t, but you’re responsible for the Medicare coinsurance or copayment. Creditable coverage If you have a pre-existing condition, you buy a Medigap policy during your Medigap Open Enrollment Period, and you’re replacing certain kinds of health coverage that count as “creditable coverage,” it’s possible to avoid or shorten waiting periods for pre-existing conditions. Prior creditable coverage is generally any other health coverage you recently had before applying for a Medigap policy. If you’ve had at least 6 months of continuous prior creditable coverage, the Medigap insurance company can’t make you wait before it covers your pre-existing conditions. There are many types of health care coverage that may count as creditable coverage for Medigap policies, but they’ll only count if you didn’t have a break in coverage for more than 63 days.”

So, essentially, as long as you’ve had continuous coverage for 6 months prior to your enrollment, the Medigap Plan cannot place any waiting periods on your pre existing conditions. For folks that are over 65 and they’re looking to save money by switching from one Medigap insurer to another – once you go through the medical underwriting and you’re approved, as long as you’ve had continuous coverage through your old Medigap plan, the new plan cannot place any waiting periods on your pre existing conditions.

If you have any other questions about Pre Existing conditions and how they work with your Medicare or Medicare Supplement policy, please feel free to contact me – stephanie@abtinsuranceagency.com or (888) 465-9728. 

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