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Medicare Supplement Pre-Existing Conditions

Medicare Supplement coverage for pre-existing conditions can begin immediately if you enroll with Guarantee Issue rights. Otherwise, you can expect to wait for 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 supplement plan, that pre-existing condition could complicate things. Pre-existing conditions don’t affect Medicare; but, they affect Medigap. This is because Medigap plans follow different rules.

Pre-Existing Condition Medicare Supplement Insurance

Medigap plans are available through private companies. They can consider your pre-existing conditions if you don’t sign up during your Medigap Open Enrollment Period.

Signing up after this may require you 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.

Advantage plans don’t have a waiting period. Yet, Advantage plans have higher per-service 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.

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. The six-month waiting period is the “lookback period”; it allows insurers to delay coverage for health conditions you sought treatment prior to 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

A 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.

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.

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 list that dictates the waiting period for each condition. During underwriting, the company will determine the guidelines. Some individuals that won’t qualify for Medigap because of chronic issues may find a Special Needs Plan more suitable.

How to 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 the carrier can’t deny coverage or charge higher premiums.

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 other coverage.

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.

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 Can I Get Guaranteed Issue Rights

You may qualify for Medigap Protection rights if you recently lost coverage; in some states, voluntary loss of coverage still qualifies you for Guarantee Issue rights. But, involuntary loss of coverage is always eligible for a Special Enrollment Period.

The Special Enrollment Period gives you rights for certain policies. The coverage you qualify for depends on your eligibility date.

Guarantee Issue rights allow you to buy without fear of denial or increases in premiums.

How to 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. Yet, many people enroll in Medigap long after the opportunity passes.

As long as you have 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 eligibility, contact one of our agents at the number above. You can also fill out a rate comparison form to see your rates now.

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.

2 thoughts on “Medicare Supplement Pre-Existing Conditions

  1. 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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