Medigap’s Coverage of Pre-Existing Conditions

While the insurance company can’t make you wait for your coverage to start, it may not make coverage of a pre-existing condition available from day 1 of coverage. A pre-existing medical condition is a health problem that you have before a new insurance policy begins. While this practice sounds harsh, the ruling is in place to prevent people from waiting to buy coverage until they get sick. Without a waiting period on pre-existing conditions, the overall costs of coverage would be significantly higher for everyone. (Reminder: This applies for only your out-of-pocket costs that Original Medicare does not cover.) The waiting period for pre-existing health problems can go for up to 6 months. After this period, the Medicare Supplement policy will cover the out-of-pocket costs associated with the condition.

Creditable Coverage
The good news is that if you have a pre-existing condition and if you enroll in a Medicare Supplement during Medigap open enrollment period, the insurance company may have to waive any waiting periods for pre-existing conditions if you recently had qualifying health coverage called “creditable coverage”. Creditable coverage is generally any other major medical coverage you recently had before applying for a Medigap policy. If your prior creditable coverage spanned at least 6 months without gaps before you enrolled in your Medicare Supplement policy, the insurance company cannot use a waiting period in covering your pre-existing conditions.