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Medicare Supplement Plans and Pre-Existing Conditions


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:

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.

FAQs

Can you change Medicare Supplement plans with pre-existing conditions?
You can change your Medicare Supplement plan at any time. However, if you’re outside of your Medigap Open Enrollment Period or don’t have guaranteed issue rights at the time, you’ll have to answer underwriting questions and could face denial or increased monthly premiums due to pre-existing conditions. When switching from Plan A to another Plan A or from Plan B through N to another Plan B through N with the same carrier, you don’t need to answer health questions.
When purchasing Medicare Supplement insurance, can you be asked about pre-existing conditions?
If you don’t purchase your Medigap plan during your Open Enrollment Period or do not have guaranteed issue rights during that time, you will have to answer questions about your health and medications when you go through underwriting. These include whether you have pre-existing conditions.
Can Medigap be denied for pre-existing conditions?
Some carriers will deny people who apply for Medigap policies due to pre-existing conditions if they need to go through underwriting.

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.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

4 thoughts on “Medicare Supplement Plans and Pre-Existing Conditions

  1. Hi! My plan F coverage begins on Feb 1,2021. I am scheduled for a cat scan of my abdomen on Jan 22.
    Should a condition be found needing further attention, will my plan F cover this?
    Should I await until after Feb 1 to be diagnosed?
    Laura

    1. Hi Laura! I wouldn’t expect your Plan F to fill in the gaps that Medicare doesn’t pay for the cat scan since it would be before your plan’s effective date. However, it should still cover any additional testing and treatment after the cat scan as long as those services are rendered on or after 2/1. I would contact your agent or carrier directly to confirm.

  2. My husband and I have AARP plan F. We are looking to change to Plan G. I was just told by a Medicare agent that we have to be free of pre-existing conditions for 2 yrs before we can change. I thought open enrollment was the time to change with no questions asked. My husband had a stent put in his carotid artery due to scar tissue from radiation back in 2012. I had a mild stroke in March 2020. The only side effects are some numbness in my left hand and foot. The Plan G premiums are way too expensive. Can you please let me know if it is true that we can’t change.

    1. Hi Kathy! Your agent is correct. The Annual Enrollment Period is for Medicare Advantage and Part D changes. It’s not meant for Medigap enrollees. There’s no annual enrollment window for Medigap plans. There is only a one time Open Enrollment Period that is 6-months long. It begins when your Part B becomes active. After your Medigap Open Enrollment window, you can change plans at any time of the year. You will just have to answer health questions.

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