Medicare supplement pre existing conditions waiting period

A Medigap policy (also known as Medicare Supplement Insurance) is an insurance policy offered by private companies to cover some coverage gaps of Medicare Part A and Part B (Original Medicare). For example, Medigap policies can pay for deductibles, coinsurance, and copayments, as well as some services that are not provided by Original Medicare, such as if you become sick while traveling overseas.

Table of Contents Show

The preexisting condition waiting period
How the preexisting condition waiting period works
Avoiding or Reducing the Waiting Period
What is a waiting period for a pre
Can I switch from an Advantage plan to a Medigap plan?
Is High Blood Pressure a pre
Can I switch from a Medicare Advantage Plan back to Original Medicare?

During the Medigap open enrollment period, which lasts for six months and begins on the first day of the month in which you’re both 65 (or older) and enrolled in Medicare Part B, the Medigap insurance company cannot make you wait for coverage to start—except under certain circumstances.

The preexisting condition waiting period

An insurance company generally isn’t allowed to make you wait for your Medigap coverage to begin, but it may be able to delay coverage if you have a preexisting condition. (A preexisting condition is a health issue or condition that you have prior to the date when the new insurance policy starts its coverage.)

This waiting period is called a “preexisting condition waiting period.”

How the preexisting condition waiting period works

The insurance company can exclude coverage for the preexisting condition if the condition was treated or diagnosed within six months before the coverage starts under the Medigap policy.

If you’re subject to a preexisting condition waiting period, the insurance company can make you wait for up to six months before it will cover your out-of-pocket costs for that condition. Once the waiting period expires, then the Medigap policy covers the preexisting condition. (Original Medicare will still cover the condition even during the preexisting condition waiting period, though the Medigap policy won't cover your out-of-pocket costs. This means you’ll be held responsible for the coinsurance or copayment.)

Avoiding or Reducing the Waiting Period

In some cases, you can either avoid or reduce a waiting period for a preexisting condition. For example, if you are replacing particular types of health insurance that count as "creditable coverage," the waiting period can be eliminated or shortened.

Generally, if you had any other health insurance that covered your preexisting condition before applying for a Medigap policy, this will count as creditable coverage. In cases where you had at least six months of continuous creditable coverage without a break in coverage of more than 63 days, there is no waiting period.

Learn more about what to do if you might encounter a waiting period for Medigap in the article, "Does Medicare Cover Preexisting Conditions?"

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What Are My Medicare Supplement (Medigap) Rights with a Pre-Existing Condition?
One of the biggest worries people have about switching to Medicare is receiving coverage while having a current health problem or pre-existing condition. Many are concerned about whether they will be able to purchase Medicare Supplement insurance – often referred to as Medigap – or whether they will be denied coverage or left with extremely expensive premiums because of a pre-existing condition. The good news is you have options and rights.

Transcript:
If you have pre-existing conditions, you may worry about whether Medicare Supplement plans will cover bills related to your illness.
WHAT ARE PRE-EXISTING CONDITIONS?
A pre-existing condition is a condition with which you were diagnosed prior to applying for a health insurance policy. For instance, if you have had Type 1 Diabetes your entire life, you have a pre-existing condition. Similarly, if you were diagnosed with Type 2 diabetes three years ago, you also have a pre-existing condition.
Insurance companies view people with pre-existing conditions as an increased risk.
Pre-existing conditions don’t include short-lived diseases from which beneficiaries recover. For instance, if you’ve ever been diagnosed with strep throat, the insurance company wouldn’t consider it a pre-existing condition.
APPLY DURING YOUR IEP FOR MEDICARE SUPPLEMENTAL INSURANCE
The Initial Enrollment Period (IEP) starts the first day of the month in which you turn age 65. During your IEP, you can apply for any Medigap insurance plan you want without worrying about your pre-existing conditions. Insurance companies that offer your desired plan in your zip code can’t increase your premium or deny your coverage based on conditions you might already have.
If you apply for Medicare Supplemental insurance outside your IEP, such as seven months after you turn 65, you become subject to underwriting. To avoid paying high premiums of eliminating your right to Medicare Supplement plans, mark your IEP dates in your calendar.
IEP vs. OEP
The IEP is different from Original Medicare’s Open Enrollment Period, which occurs once per year from October 15 to December 7. The OEP applies primarily to beneficiaries of Medicare Part C, which is also called Medicare Advantage (MA). If you have a Medicare supplemental insurance plan, you won’t be able to switch without becoming subject to underwriting.
Insurance companies use underwriting to determine a beneficiary’s risk and to adjust premium prices accordingly. Should underwriting apply, the insurance company can increase your Medigap insurance premium considerably or deny you coverage altogether.
UNDERSTAND THAT A SIX-MONTH WAITING PERIOD MIGHT APPLY FOR MEDIGAP INSURANCE
Some insurance companies institute a six-month waiting period for new beneficiaries of Medicare Supplement plans. During this time, your plan won’t cover costs related to your pre-existing condition. However, once the waiting period elapses, the insurance will begin to pick up those costs.
The pre-existing condition waiting period doesn’t apply to Original Medicare. You’ll still receive coverage for your condition, but you’ll be responsible for co-payments, co-insurance, and deductibles.
In some cases, the waiting period won’t apply at all. If you have continuous creditable coverage from a different health insurance company during the six months prior to applying for your Medigap insurance, your coverage will begin immediately. Similarly, if you have creditable coverage for a shorter time frame, you can reduce your waiting period by that amount.
CONCLUSION
Pre-existing conditions can prove difficult to navigate when it comes to health insurance. Fortunately, Medicare preserves your rights when you apply for Medicare supplemental insurance during your IEP or when you have guaranteed issue rights.

What is a waiting period for a pre

The waiting period is the time between signing up for a Medigap and the start of coverage. This waiting period is generally imposed if you have a pre-existing condition and have not had prior creditable coverage for a certain amount of time. « Back to Glossary Index.

Can I switch from an Advantage plan to a Medigap plan?

Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare drug plans. If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.

Is High Blood Pressure a pre

Other Types of Pre-existing Conditions Hypertension (high blood pressure) is an example of one such common pre-existing condition affecting more than 33 million adults under 65.

Can I switch from a Medicare Advantage Plan back to Original Medicare?

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.

medicare supplement pre existing conditions waiting period