If you want to enroll in Medigap outside certain Medicare Supplemental guaranteed issue periods, you may be subject to Medical underwriting and waiting periods if you have pre-existing conditions.   Some people with certain pre-existing conditions on the application may pay a higher price and others can be declined from Medigap coverage altogether.

Enrolling in Medigap with Preexisting Conditions

If you enroll during your Medigap initial enrollment period or other guaranteed issued periods, you do NOT have to answer medical questions and you will not be subject to pre-existing waiting periods.  You will also be guaranteed to pay the lowest available price.

You may have to answer health questions on the application or over the phone and could be subject to up to a 6 month waiting period before certain pre-existing conditions are covered by your new plan if you apply outside guaranteed issue periods. A Medigap insurance provider can increase your price or turn you down based on how you answer health questions on the application.

Most applications for non-guaranteed issue applicants feature 20 or more questions about your health.  Each company develops its own list of health questions.  Based on your answers, you will either be approved at the best rate, approved at a higher rate with waiting periods for pre-existing conditions, or declined.

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Turned down for Medigap due to Pre-Existing condition?

Yes, it is possible to be declined coverage for Medigap if you apply outside your guaranteed enrollment windows.  Each insurance provider handles this differently.  Some will only decline applicants for major pre-existing conditions such as cancer or stroke.  Others can turn applicants down for recent trips to the emergency room or certain medications.  If you have a pre-existing condition and are concerned you will not be approved, please contact Senior65.com for guidance on the best chances of approval

Medigap Preexisting Waiting Period

An insurance provider who approves you with prior health conditions can delay covering your preexisting condition for up to 6 months.  This is called the “preexisting condition waiting period” and it only applies to those who missed their initial Medigap enrollment and do not qualify for guaranteed issue Medigap.

The maximum waiting period for prior conditions is 6 months. Any waiting period for a prior medical condition will be reduced by one month for each month you were enrolled in creditable coverage before you purchased a Medigap plan.  So, for example, if you had creditable coverage for 4 months prior to Medigap, your waiting period would be reduced to just 2 months.  If you had six or more months of previous creditable coverage with no breaks longer than 63 days, you will have no waiting period.

Medicare Coverage of Preexisting Conditions.

You will still be covered by Original Medicare, regardless of your preexisting condition and Medigap waiting periods. So while Medigap may limit coverage for pre-existing conditions for some people, Medicare will not.

New Health Conditions while on Medigap

Should you have new health issues while on Medigap, your plan must cover treatment.  You plan cannot increase your monthly price for any conditions that are diagnosed after you have been accepted on a plan.

Switching Medigap plans with Pre-existing conditions

Should you want to switch to a different Medigap plan in the future, this may be tricky if you have certain pre-existing conditions.  in most states, switching to a lower-cost version of your same plan or a new lettered Medigap plan will require you to apply and go through Medical underwriting.  The new company can, once again, approve you at the best rate, a higher rate, or decline you for pre-existing conditions.  If you are approved for a new plan, you typically will not be subject to waiting periods before the pre-existing condition is covered.

There are many state-specific rules and tricks for switching Medigap plans when you have a pre-existing condition.  Check out our Ultimate Guide to Medicare Switching to learn more.

For further questions about a Medigap plan call 800-930-7956 or click here to get a Medigap quote.