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Q: Does Medigap Cover Pre-Existing Conditions?

Asked by Anonymous on October 12, 2017

Howard Yeh
Howard Yeh October 12, 2017

In short, yes, Medigap covers pre-existing conditions. Once you’re enrolled in a Medicare Supplement plan, it will always cover your pre-existing conditions.

Exceptions

There are, though, a few exceptions to this:

  1. If you didn’t have equivalent insurance coverage (also called “creditable coverage”) when you enrolled, then your plan can delay coverage for pre-existing conditions for up to 6 months. You may be subject to a 6-month waiting period before your out-of-pocket expenses associated with that condition will be covered.
  2. If you delay enrolling in a Medicare Supplement plan until your Open Enrollment Period is over, then insurers may decline to offer you a plan. If you’re allowed to enroll, you may be subject to a 6-month waiting period before your out-of-pocket expenses associated with pre-existing conditions will be covered.
    • You will also be charged higher monthly premiums for a plan if you are allowed to enroll. This is called medical underwriting – that is, a higher price due to your health conditions. You have the right to enroll without underwriting if you select a plan during your Open Enrollment Period.

In either scenario, your pre-existing conditions will still be covered by Medicare. Your Medigap coverage simply won’t extend to cover those conditions for up to 6 months.

If you successfully switch between Medicare Supplement plans, your new plan cannot exclude coverage for any pre-existing conditions.

Taking the Next Steps

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