Medigap Coverage of Pre-Existing Conditions

By Joan Opiyo
eMedicareSupplements Contributor

How Will Medigap Cover Your Pre-Existing Conditions?

The coverage of pre-existing conditions is a common concern among seniors. Whether or not your Medigap policy will cover pre-existing conditions depends on when you choose to enroll in Medigap. Pre-existing conditions are defined as any illnesses or conditions for which you received diagnosis or treatment prior to the start of your Medicare supplement coverage. Your pre-existing conditions will be covered if you have a right to Medicare supplements under the guaranteed issue provisions for Medigap. Guaranteed issue rights ensure your enrollment in any Medicare supplement plan and the coverage of any pre-existing conditions you might have.

Additionally, you may enroll in Medigap and receive continuous coverage for pre-existing conditions if you have received creditable coverage from a qualifying insurance policy for six or more months before your Medicare supplement enrollment and it has not been more than 63 days since this coverage lapsed. If you don't meet these qualifications, you may have to wait up to six months for Medigap coverage of pre-existing conditions, according to federal rules. Insurance that qualifies as creditable coverage includes any Medicaid health plan, private individual health plans, COBRA, group employer plans, TRICARE or CHAMPUS, any public health plan (federal, state or local), Tribal Organization Program or Indian Health Service, state health insurance risk pools, Veterans benefits or health insurance obtained through the Peace Corps.

If you have had a Medigap policy for more than six months and now want to replace it with a new Medicare supplement policy, there will be no lapse in coverage for benefits offered by the old policy that are also offered by the new plan. But you may have to wait up to six months for any benefits in the new Medigap plan to kick in. Some Medicare supplement plans do not require waiting periods for pre-existing conditions. If you don't have creditable coverage, look for a plan in your area that offers affordable coverage and will not delay coverage of any pre-existing conditions.

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