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Can I get a Medigap policy if I have a pre-existing condition?

By Christian Worstell

You have guaranteed access to a Medicare Supplement insurance policy if you buy during your Medigap open enrollment period, even if you have a pre-existing condition. It’s possible to get a policy after the enrollment period, but it’s not guaranteed.

During the open enrollment period, insurers cannot use underwriting. That means they cannot deny you Medigap coverage because of a pre-existing condition or force you to pay a higher premium.

Medigap pre-existing condition waiting period

If you buy a Medigap policy outside your open enrollment period, your insurer may enforce a waiting period that lasts for up to 6 months. During this period, your insurer will provide coverage, but it can refuse to cover out-of-pocket costs related to treatment of the pre-existing condition. After the “pre-existing condition waiting period,” these costs will be covered.

Guaranteed access after open enrollment

Once the open enrollment period ends, consumer protections shrink for those with pre-existing conditions. There are only five situations that give you guaranteed access to Medicare Supplement insurance after open enrollment. If any of those five situations apply to you, you have what is referred to as a “guaranteed issue right.” If you have a guaranteed issue right, an insurance company must sell you a Medigap policy, must cover all pre-existing conditions, and cannot charge you more because of your pre-existing condition.

You have a guaranteed issue right in the following five situations:

  1. You have a Medicare Advantage Plan and it’s leaving Medicare or ending coverage in your area.
  2. You have Original Medicare and need to replace an employer health plan that will soon discontinue.
  3. You have Original Medicare and a Medicare SELECT policy and you move out of the policy’s service area.
  4. Your Medigap insurance company goes bankrupt or ends your policy through no fault of your own.
  5. You leave a Medicare Advantage plan or Medigap policy because the company misled you or didn’t follow the rules

Guaranteed issue rights protect you, but they must be utilized quickly. In order to qualify for a Medigap policy without underwriting, you must apply no later than 63 calendar days after your previous health coverage ends.

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