Pre-Existing Conditions and Medicare?? (medical, plan, hospital, supplement)

[reubenray]

I will have the option to enroll into a Medicare Supplemental Plan as early as next month. As I read as much as I can and pick which company to use I saw a note in one of the many documents concerning pre-existing conditions. I read that I may not get insurance for the first 6 months and then I read that if I enroll as early as I can this does not happen. I plan on getting a HD-F plan.

What is correct?

[Ariadne22]

Originally Posted by reubenray

I will have the option to enroll into a Medicare Supplemental Plan as early as next month. As I read as much as I can and pick which company to use I saw a note in one of the many documents concerning pre-existing conditions. I read that I may not get insurance for the first 6 months and then I read that if I enroll as early as I can this does not happen. I plan on getting a HD-F plan.

What is correct?

The second statement is correct. Per Medicare.gov:

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period, because you can buy any Medigap policy sold in your state, even if you have health problems.

This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance).

After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more.

Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.

However, if you apply during your Medigap open enrollment period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health.

https://www.medicare.gov/supplement-...y-medigap.html

No worries at this time. If you decide a few years down the road you want a full Medigap F/G, then you will need to undergo health underwriting. If, on the other hand, you decide later you prefer an Advantage plan, you will be able to enroll without health underwriting during Annual Open Enrollment between Oct. 15 - Dec. 7.

Additional information on when you can buy/switch outside of the 6-month Medigap open enrollment period:

https://www.medicare.gov/supplement-...#collapse-2513

[Moshe Nelkin]

It is correct that for the first six months that you are enrolled in Medicare you have an Open Enrollment period. During this time, a company can't turn you down for coverage due to a health condition. But the can still apply a pre-existing condition exclusion. For example, suppose you have a heart condition, and a company has a three-month pre-existing condition exclusion. If you received treatment for or advice about your heart condition during the three months before you sign up for coverage, the company can refuse to pay for heart condition treatments that you get for the first three months that you have your policy. So because of Open Enrollment they must sell you the policy even though you have a heart condition. But because of the Pre-Existing Exclusion clause they can refuse to pay your heart condition claims for the first three months that you have your policy.

Moderator cut: NO advertising

[Ariadne22]

Originally Posted by Moshe Nelkin

So because of Open Enrollment they must sell you the policy even though you have a heart condition. But because of the Pre-Existing Exclusion clause they can refuse to pay your heart condition claims for the first three months that you have your policy.

This is true only if enrollee was without creditable coverage prior to applying for the Medigap - per medicare.gov:

If you have had at least 6 months of continuous prior creditable coverage, the Medigap insurance company can't make you wait before it covers your pre-existing condition.

https://www.medicare.gov/supplement-...y-medigap.html

[Moshe Nelkin]

That is correct - thank you for the clarification. Because of Creditable Coverage, most people enrolling in Medicare at age 65 will not need to be concerned about pre-existing condition limitations. Creditable Coverage includes a health insurance policy that provides primary reimbursement for medical and hospital care, Part A or Part B of Medicare, Medicaid, Champus, FEHBP, and a few other government programs.


Here is the language from the policy of a popular Medigap company:


[SIZE=3][SIZE=3]This policy will not cover loss due to Preexisting Condition(s) unless the expense for that loss is
incurred more than six (6) months after the effective date of coverage. This provision does not apply if, as of the date of application, You had a Continuous Period of Creditable Coverage or had prior coverage under a Medicare Supplement policy for at least six (6) months. If, as of the date of application, You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied. This provision does not apply if You applied for and were issued this policy under guaranteed issue status.
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[justNancy]

Originally Posted by Moshe Nelkin

It is correct that for the first six months that you are enrolled in Medicare you have an Open Enrollment period. During this time, a company can't turn you down for coverage due to a health condition. But the can still apply a pre-existing condition exclusion.

That's not what I was told when I called Medicare, but you're correct. I used to sell Medicare Supplements but I wasn't sure if some things had changed in the past few years. Thank you for giving us the correct information.