Medigap: How Does it Handle Preexisting Conditions?

Learn when Medigap can decline or have waiting periods for pre-existing health issues

by Ray Wilson+ on Mar 21, 2019 | 14 Comments

If you enroll in a Medigap policy during your initial enrollment period (usually when you first turn 65)  your policy cannot deny you coverage because of a pre-existing condition.  This means if you apply for Medigap when you are first eligible you are guaranteed to be approved regardless of your current health.  Medigap can, in some circumstances, enforce a waiting period before treatment for certain preexisting conditions is covered.

This article was updated on March 21, 2019 to reflect new information

Medigap: Preexisting Condition Waiting Period

If you had a gap in health coverage before you enrolled in Medigap, you may have to wait up to 6 months after your Medigap start date before certain preexisting condition are covered. This waiting period may vary by insurance company. Original Medicare must still cover its portion of your preexisting condition during this time as Medicare does not have waiting periods for pre-exisiting conditions.

How to Avoid Preexisting Condition Waiting Period

The secret to avoiding waiting periods is to have “credible coverage” 6 months before applying for Medigap.  Credible coverage is usually the health coverage that you had through work, spouse or through an individual plan.  You can contact your previous plan to check if it is considered “credible” by the Center for Medicare Services (CMS).  Here are the things you need to consider to avoid waiting periods:

  • No lapse of current coverage for more than 63 days
  • Current policy has been in force for at least 6 months and is considered credible coverage by CMS
  • Enroll in Medigap as soon as you are eligible
  • Don’t drop your current coverage until you have received confirmation from your new policy

Missed the Medigap Initial Enrollment?

If you missed your initial open enrollment period (OEP) you will most likely need to undergo medical underwriting and a preexisting condition may preclude you from being enrolled into a policy. You may be eligible to enroll in a Medigap plan during the Special Enrollment Period (SEP). An SEP follows a life-changing event such as losing your health coverage by moving or your work stops offering it to you.

For further questions about how Medigap handles preexisting conditions call the number above or contact Senior65.

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Reader Comments and Questions

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By Lorraine on April 12, 2019

I am eligible for Medicare in August and am on SSDI and need knee replacement surgery. Will I be able to schedule the surgery in August or is there a waiting period to do so.
Thank you. Lorraine

Lorraine,
You should contact Medicare directly with this question since we do not have access or manage this information. Senior65 helps people understand how Medicare works in general so that they can judge if they want additional coverage such as a Medigap plan. We can help people enroll in additional Medicare insurance at no additional cost.
-Chris from Senior65.com


By JoAnne on March 30, 2019

I was just denied a medigap policy because of a pre-existing condition. I thought the ACA made it illegal to do this? Why are we not protected for for these policies?

JoAnne,
That ACA rule was designed for under 65 enrollment. When you turn 65 there is an Initial Enrollment Period in which you get guaranteed issuance when trying to enroll in Medigap. In other words, you can't get rejected. When that period ends you have to go through medical underwriting (and risk getting rejected) unless you qualify for Special Enrollment Period.

Nevertheless, if you give us a call we can review your situation and help you apply for the company that will offer the highest chance of approval.
-Michelle from Senior65.com


By Reba on November 08, 2018

My husband was has prostate cancer, diagnosed in 2017. We had a advantage plan with Aetna, and found out quickly most doctors would not accept it.. I went back to regular medicare only in 2018. During this enrollment I tried to enroll him in a medigap plan and was denied. I found was denied also by the same company because I was treated for llymphomia in 2011. I did find a policy for myself, but is there one for my husband. He is being treated now for his cancer. The treatment center he is going to does not take most of the advantage plans.

Reba,
We know of no Medicare Supplement (Medigap) plans that will accept him while being treated for cancer if he is outside his guaranteed issued periods. If you ever move outside your current Medicare Advantage (MA) network that would trigger a special enrollment period and he then would be approved.

-Chris from Senior65.com


By Lorrie on July 26, 2018

I am 66 and on Medicare. I live in Florida. I did not sign up for a supplement plan during my open enrollment period. I have a pre-existing condition. Looking to have knee replacement about 6 months out. Are there ANY supplement plans that I can get, now?

Lorrie,
It has been our experience that no insurance companies that offer Medigap will approve applicants that answer yes to the following question: "Has a procedure been recommended by a medical professional that hasn't taken place yet." This assumes that you are outside your initial enrollment and do not qualify for special enrollment such as moving out of our current plans coverage area. Sorry we don't have better news. Once you are symptom and treatment free for two or more years your odds of approval go way up.
-Chris from Senior65.com


By Dennis on July 13, 2018

I am 67 and have medicare A and B along with my original BCBS plan "F" high deductible. I have since been diagnosed and treated for Carcinoid cancer. I would like to switch to the standard plan "F" and avoid the deductibles. I have been told that I should have done that when I initially signed up. And that nobody will sell me a plan "F" without an extraordinarily high premium. If at all. But I have also been told that if I have not been treated within the past six months, then they can't ask me about it. I suspect they will know however since they have been paying for the treatments. Is that an accurate evaluation?

Dennis,
If it very hard to switch from Medigap High F to F after being treated for cancer. You would have to go through medical underwriting. Each insurance provider asks different questions but they are not limited to the last 6 months. Most often if you have had cancer you must be symptom and treatment free for 5+ years.
-Eric from Senior65.com


By Ed on May 02, 2018

I live in Illinois. I have a Medicare Advantage Plan but would like to switch back to a supplement. I have afib and take high blood pressure meds. Any companies out there that would take me.

Ed,
Atrial Fibrillation may be an issue depending on the medications you are taking. Each Medicare Supplement provider handles medical underwriting differently. Give us a call and can discuss your case to see if we can match you with a provider that gives you the best chance of approval.

If you have had your Medicare Advantage (MA) plan for less than one year, then we can switch you without medical underwriting as part of your trial right period.

-Eric at Senior65.com


By karel on December 10, 2016

I need cataract surgery. I am turning 65 in March 2017 and am applying for medicare & supplement coverage starting in March 2017. I have coverage under obamacare now until March 2017. Will there be a 6 month waiting period??

Karel,
There should not be a waiting period since you will be applying during your initial enrollment period, and you've had creditable coverage leading up to your enrollment. If you need help finding the right Medicare Supplement plan call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Chris from https://www.senior65.com/


By Rosalind on December 09, 2016

When exactly is the medigap open enrollment period? I have been applying over the past month and am being rejected for pre-existing conditions. I have now and have had a supplement for the past 10 periods, but was looking to switch to a cheaper plan. Thank you.

Rosalind,
Unfortunately, in most states you only have one Medigap guaranteed issuance period (when you first enroll), unless there are special circumstances. With that said, we consider ourselves the Medigap switching experts, and know that some companies make switching easier than others. Call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Eric from https://www.senior65.com/


By Steven Rouse on October 24, 2016

I enrolled in Medicare June 2015 when I turned 65. I subsequently was diagnosed with prostate cancer in February 2016. Medical is my secondary policy as I am still carried on my wife's insurance. She will retire in December and Medicare will be come my primary. I applied for Supplemental Plan F in October 2016 once it was determined I needed treatment and was denied due to medical condition. My wife seems to believe there is another open enrollment period for Medicare when I can add the supplemental and not be denied even with a pre-existing condition. Is this true? When?

Steven,
Your wife is right! There is a Special Enrollment Period for Medicare Supplement plans when you leave your job-based insurance. You may have been denied because you didn't mark that you had a guaranteed issuance period, or you applied for a plan that didn't qualify you for guaranteed issuance. If you need help enrolling, please call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Patricia on October 12, 2016

Last year( within the open enrollment period) I applied for Medicare supplemental insurance plan F and was denied because of an assessment by an Orthopedic surgeon who said I had impending surgery for a knee problem. In the report of the visit to the surgeon, it was not reported that I declined the surgery because I thought the statistics were not worth undergoing the procedure. When declined my application they asked me to phone them as to why I was rejected. I guess they figured that if they didn't have the info in writing that I couldn't fault them for the denial. I thought it was against the law to consider existing conditions????

Patricia,
The only times Medicare Supplement has guaranteed issuance is when you first become eligible for Medicare, or if you have a Special Enrollment Period. Outside of these periods, you can be denied or charged more for preexisting conditions.

With that said, we consider ourselves the enrollment experts, and have found some companies easier to get enrolled in than other companies. If you would like to try again, we'd be happy to help you apply for a Medigap plan. Just call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By goldie nemeth on February 07, 2016

I am retiring March1 2016. I took out medicare last year when I turned 65 part A & B and found out I need two knee replacements. before going on medicare.. I signed up for medigap F plan last week and always had insurance thru G E, MVP and the company switched over to Blue Cross this Jan. Will I be covered for knee surgery in April or do I have a pre- existing condition waiting period of 6 months?

Goldie,
If you are in your Medigap initial enrollment period or have guaranteed issuance, you should not have waiting periods. With that said, you should contact your new provider to confirm your status. Best of luck!
-Chris from https://www.senior65.com/


By mary on December 19, 2015

I start both medicare and a medicare supplemental policy on January 1, the month, I turn 65.the supplemental policy from state farm in VA, has no waiting period for prexisting condition and I have years of prior credible coverage through 12 31 15, if it did require waiting periods. Yet tishe policy states it excludes "expenses for confinement in a hospital or SNF beginning before your effective date of coverage". So if I have appendicitus or a car crash on Dec 30 that keeps me in hospital thru Jan 6, the agent says that would not be covered . is that legal?

Mary,
We totally understand your concern. We suggest you contact the Virginia State of Insurance to confirm this information and your provider to confirm.
-Chris from https://www.senior65.com/


By Christin4e on December 07, 2015

My husband just had back surgery--and I want to put him in a medicare supplement. He has been enrolled in a medicare advantage fr several years. I was told he would be denied in underwriting. Is that true?

Christine,
That isn't necessarily true. It will depend on the state he lives in, if he has a qualifying event, and if he doesn't have a qualifying event, the plan may have waiting periods. If you would like a quote please call us at 800-930-7956.
-Eric from https://www.senior65.com/


By Jim Rollins on November 30, 2015

Which medigap providers accept applicants with COPD?

Jim,
All Medicare Supplement providers must accept all persons with COPD or other preexisting conditions if you apply during a guaranteed issuance period. If you apply outside of that time, you could be denied or charged more.
-Eric from https://www.senior65.com/



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