Pre-existing Health Care Conditions Covered Under Medicare
1. If you do not sign up for or purchase a Medicare Supplement insurance policy during your "guarantee issue period" based
on national laws Medicare supplement policies can refuse to cover prior medical conditions for the first six months.
2. The wait time for coverage to start is called a pre-existing condition waiting period. You can avoid waiting periods if you
buy your policy when you have a guaranteed issue right. If you buy your policy when you have guaranteed issue rights,
insurers can never refuse to cover prior medical conditions coverage for any period of time.
a. Make sure you buy a Medigap in advance of enrolling in Medicare so you do not have any gaps in coverage. If you
already had Part B when you turned 65, your open enrollment period to buy a Medicare Supplement (Medigap) policy
begins the month of your 65th birthday.
b. If you miss your open enrollment period, you can also buy a Medigap when you have a guaranteed issue right.
If you are age 65 or older, you have a guaranteed issue right within 63 days of when you lose or end certain kinds of
health coverage. This includes:
• If you had group health insurance (through either current or previous employment) that paid after
Medicare and lost it through no fault of your own, you have the right to buy most Medigap policies.
• If you joined a Medicare Advantage plan when you first became eligible for Medicare and disenrolled
within 12 months, you have the right to buy any Medigap policy offered in your state by any insurance
company.
• If your previous Medigap policy, Medicare Advantage plan, PACE program ends its coverage or commits
fraud, you have the right to buy most Medigap policies.
c. If you have a Medicare Advantage plan, Medicare SELECT policy or PACE program and you move out of the plan's
service area, you have the right to buy most Medigap policies.
• When you have a guaranteed-issue right, companies are required to sell you a policy at the best
available rate, regardless of your health status, an insurance company cannot deny you coverage.
The best available rate may depend on a number of factors, including your age, gender, whether
you smoke and where you live. Companies cannot make you wait for coverage of pre-existing
conditions if you have a guaranteed issue right.
3. Buying a Medigap outside of Protected Enrollment Periods
a. You may run into problems if you wait until outside the Medigap policy protected enrollment periods.
Insurance companies can refuse to sell you one or may only let you buy one under restricted or
certain medical requirements. If an insurance company agrees to sell you a policy you will probably
need to pay a higher monthly premium and you may need to wait six months before the Medicare
Supplement (Medigap) will cover pre-existing conditions.
b. Contact Medicare Supplement (Medigap) insurers in your state to find out if they will sell you a
Medigap policy outside of protected enrollment periods.
4. Cancelling a Medicare Supplement (Medigap) Policy
• You have the right to review a new Medicare Supplement (Medigap) policy for 30 days. You can cancel it within that
time for a full refund if it does not meet your needs. After the first 30 days, you can cancel your policy at any time.
Beware when cancelling. Depending upon where you live, you may not be able to buy another policy, or Insurance
companies can charge you more because of your health.
Open enrollment (click here)
Due to Governmental regulations and the many different Medigap and Advantage opportunities we are unable to advise
until we are aware of your needs and get your permission to advise.
Medicare
Pre-Existing Conditions
Medicare Supplements
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