Does Medigap Cover Preexisting Conditions?

Calendar Icon Updated May 07, 2019
Medicare

Coverage of pre-existing conditions by Medigap is a subject that generally isn’t given much thought. While many carriers do not have a waiting period on these conditions, some do and more are likely to join.

Pre-Existing Condition Coverage by Medigap

If you are applying for a Medicare Supplement plan (Medigap), when you first become Medicare eligible, you will be guaranteed coverage under the initial “open enrollment” period. However, this should not be confused with immediate coverage for pre-existing conditions. Coverage is guaranteed, but a 6-month waiting period may apply on pre-existing conditions depending on the carrier.

If you have Guaranteed Issue rights to receive Medigap coverage because you are losing employer coverage involuntarily or voluntarily, there still may be a 6-month waiting period on any pre-existing conditions depending on the specific carrier.

Waiting Periods on Pre-Existing Conditions

Carriers have the right to apply the 6-month waiting period, however, many do not. Many carriers will allow prior creditable coverage to count towards the 6-month waiting period. For example: ‘if you had creditable coverage for 3 months prior to enrolling in Medicare and purchasing a supplemental plan, the waiting period would only apply for three months.’

It is important to understand whether your prior coverage was creditable and if the carrier has a waiting period on the pre-existing conditions. Also, know that any condition that becomes present prior to the effective date of your Medigap coverage will be considered pre-existing even though the policy has already been approved and issued.

Still have questions? Take a look at our blog to learn more about Medigap and Medicare coverage, or call us at 855-802-1206. We’re here to take the confusion out of the Medicare system and make things as easy for you as possible. We are available from 6am to 7pm MT, Monday to Friday and 7am to 5pm MT on Saturday. We are closed on Sunday.

Micah Pratt

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