Medicare Supplement coverage for pre-existing conditions can begin immediately if you enroll with guaranteed issue rights. Otherwise, you can expect to wait six months before coverage of your pre-existing condition begins. Pre-existing conditions include cancer, heart disease, and asthma. According to the Department of Health and Human Services, up to 50% of non-elderly Americans have a pre-existing health condition.
While pre-existing conditions don’t affect Medicare, they can affect Medigap eligibility. A pre-existing condition can slow down the process when applying for a Medicare Supplement plan.
Medicare Supplement Plans and Pre-Existing Conditions
Medigap plans are available through private companies. When applying for a Medigap plan, your pre-existing conditions may be taken into consideration if you don’t sign up during your Medigap Open Enrollment Period.
If this window has passed for you and you don’t have guaranteed issue rights, you’ll need to answer underwriting health questions when signing up for your policy. In this case, you may need to wait six months for your pre-existing condition to have coverage. The six-month waiting period begins once your policy starts. These pre-existing condition waiting periods only apply to Medigap policies.
Understanding the Waiting Period for a Pre-Existing Condition
Federal law doesn’t require insurers to cover pre-existing conditions for the first six months. The six-month waiting period is also known as the “look-back period,” meaning insurers can delay coverage for health conditions that you sought treatment for before applying. During this waiting period, Part A and Part B continue to provide coverage for pre-existing conditions.
Once the waiting period ends, the Medigap policy covers 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?
For the first six months after you enroll, a Medicare Supplement plan can cover the Part A coinsurance when the visit doesn’t relate to the pre-existing condition. A visit relating to a pre-existing condition won’t have coverage.
Although Medicare will pay some of the hospital bills, you pay the rest. This is because Medicare doesn’t have a pre-existing condition waiting period like Medigap. Those with a pre-existing condition enrolling in or changing Medigap plans outside of the OEP need to budget to ensure they’re able to cover any medical costs for six months.
What Pre-Existing Conditions Are Not Covered by Medicare Supplements?
The pre-existing conditions that cause denial for a Medigap plan vary by carrier. However, some individuals won’t qualify for Medigap because of chronic issues including:
- ALS (Lou Gehrig’s Disease)
- Chronic obstructive pulmonary disease (COPD)
- End-Stage Renal Disease (ESRD)
This list does not include every condition for which someone could be denied during underwriting. Some carriers, such as United American are known for being less strict with issuing Medigap policies to people with pre-existing conditions People managing such conditions may find a Special Needs Plan more suitable.
How Do I Avoid the Medicare Supplement Waiting Period?
You can avoid the waiting period by buying your plan during your Medigap Open Enrollment Period. Your Open Enrollment Period gives you a one-time right to enroll in a Medigap plan of your choosing. Enrolling in Medigap during the Open Enrollment Period means that the carrier can’t deny coverage or charge higher premiums.
The good news is that the Medigap pre-existing condition waiting period is often reduced by the number of months that you had creditable coverage before enrolling. Having credible insurance for six months before Medigap could eliminate the waiting period. Thus, those with six months of creditable coverage before Medigap shouldn’t worry about the carrier implementing a waiting period. Employer-sponsored health plans from companies with more than 20 employees are an example of creditable coverage.
If you had six or more months of creditable coverage prior to enrolling, the Medigap carrier MUST provide coverage immediately. But, if you had more than a 63-day gap, you cannot use creditable coverage to reduce your pre-existing condition waiting period.
How to Get Medigap with a Pre-Existing Condition
Whether or not you have a pre-existing condition, enrolling in a Medigap plan during your Open Enrollment Period is the best course of action. Yet, many people enroll in Medigap long after the opportunity passes.
If you're looking for help navigating Medigap enrollment with a pre-existing condition, contact one of our agents at the number above. They'll assist you in finding the best plan for your needs. You can also fill out a rate comparison form to see your rates now.