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.