Medicare Supplement coverage for pre-existing conditions can begin immediately if you enroll with Guarantee Issue (GI) rights. Otherwise, you can expect to wait about 6-months before coverage on your pre-existing condition begins.
If you have a pre-existing condition, such as cancer, heart disease, or asthma, you’re not the only one. According to the Department of Health and Human Services, up to 50% of non-elderly Americans have a pre-existing health condition.
When you need to apply for a Medicare supplement insurance plan, that pre-existing condition could complicate things. Pre-existing conditions don’t affect Medicare; however, they affect Medigap. This is because Medigap plans by private insurance companies follow different rules.
Knowing your enrollment periods can minimize the effect pre-existing conditions have on coverage.
Pre-Existing Condition Medicare Supplement Insurance
Medicare supplement plans or Medigap plans are available through private insurance companies. They can consider your pre-existing conditions if you don’t sign up during your Medigap Open Enrollment Period (OEP).
Signing up after this period may require you to wait six months for your pre-existing condition to have coverage. This six-month waiting period begins once your policy starts, and can have significant implications on your out-of-pocket medical costs.
The waiting period for a pre-existing condition may not go beyond 6-months.
These pre-existing condition waiting periods only apply to Medigap policies. Medicare Advantage plans don’t have a waiting period.
However, Medicare Advantage plans generally have higher out of pocket costs since the premiums are so low. With insurance, you either pay a little before you need the service or a lot when you need the service.
It’s either higher premiums and lower out of pocket costs or lower premiums and much higher out of pocket costs.
Understanding the Waiting Period for a Pre-Existing Condition
Federal law allows insurers to refuse to cover pre-existing conditions for the first six months of coverage. This six-month waiting period is the “lookback period”; it allows insurers to delay coverage for health conditions you sought treatment for prior to applying.
Once the waiting period ends, the Medigap policy covers out-of-pocket costs like deductibles and copays. It’s important to understand what the waiting period might mean for your health care needs.
Do Medicare Supplement Plans Cover Pre-Existing Conditions
A Medicare Supplement plan can cover the Part A coinsurance when the visit doesn’t relate to the pre-existing condition. This lasts for the first 6-months of coverage.
However, a visit relating to a pre-existing condition won’t have coverage. Although Medicare will pay some of the hospital bills, and you pay the rest.
This is because Medicare doesn’t have a pre-existing condition waiting period like Medigap insurance. Medicare can cover, even when Medigap won’t; this is because Medicare is your primary insurance provider and the Medigap company is secondary.
Those with a pre-existing condition, enrolling in or changing Medigap outside of the OEP need to budget. You need to ensure you can cover any medical costs for six months.
List of Pre-Existing Conditions Not Covered by Medicare Supplements
Currently, there is no specific list that dictates the waiting period for each condition. During underwriting, the insurance company will determine the specific requirements and guidelines.
Some individuals that don’t qualify for Medigap coverage because of chronic issues may find a Special Needs Plan more suitable.
Avoid the Medicare Supplement Waiting Period
You can avoid the six-month waiting period by strategically buying your Medicare supplement plan. To avoid the waiting period, purchase a Medigap plan during your Medigap Open Enrollment Period.
This period starts once you’re at least 65 and have a Medicare Part B policy, and it lasts six months. Your OEP gives you a one-time Guarantee Issue right to enroll in a Medigap plan of your choosing.
Enrolling in Medigap during OEP means the carrier can’t deny coverage or charge higher premiums because of pre-existing conditions. Purchasing Medigap outside OEP could cost more unless you had creditable coverage. Those without creditable coverage wouldn’t be eligible for GI rights.
Those with six months of creditable coverage before Medigap shouldn’t worry about the carrier implementing a waiting period. Creditable coverage could be from an employer, TRICARE, or another form of health coverage.
The good news is that the Medigap pre-existing condition waiting period is often reduced by the number of months (up to six months) that you had creditable coverage before enrolling. Having credible insurance for six months before Medigap could eliminate the waiting period requirements.
If you had six or more months of creditable coverage prior to enrolling, the Medigap carrier MUST provide coverage for any prior medical conditions immediately. However, if you had more than a 63-day gap in coverage, you cannot use creditable coverage to reduce your pre-existing condition waiting period.
How Can I Get Guaranteed Issue Rights
Beneficiaries may qualify for Medigap Protection rights if they have recently lost coverage; in some states, voluntary loss of coverage still qualifies you for GI rights. However, involuntary loss of coverage is always eligible for a Special Enrollment Period (SEP).
The SEP gives you GI rights for certain policies. The coverage you qualify for depends greatly on your location and eligibility date.
Guarantee Issue rights are Medigap protection; beneficiaries can purchase coverage without fear of denial or increases in premium rates due to health.
Get Supplemental Insurance with a Pre-Existing Condition
If you have a pre-existing condition, enrolling in a Medigap plan during the Open Enrollment Period is important. This is the best time to enroll since the insurer can’t deny you coverage or charge you a higher premium.
However, many beneficiaries enroll in Medigap long after the OEP opportunity passes. These people finish the pre-existing waiting period and find satisfaction in new quality coverage.
The best things in life are worth waiting for, and Medigap coverage is certainly worth the wait. As long as you have Medicare Part B, you can buy a supplement at any time, if you qualify of course.
If you have Medicare and you’re unsure about your Medigap eligibility, contact one of our brokers at the number above. You can also fill out a rate comparison form and get the process started online.