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Are You Eligible for a Medigap if You Have Pre-Existing Conditions?

Pre-existing Conditions and Medicare

Pre-existing conditions are medical conditions that you had prior to the date your new health care benefits started. With a Medicare supplement specifically, pre-existing conditions are defined as conditions you had before your Medicare supplement start date. With Original Medicare, you’ll receive all Medicare benefits regardless of any pre-existing conditions. However, if you’re considering a supplement, you’ll want to be a bit more careful about your enrollment to ensure eligibility.

Let’s deep dive into how your pre-existing conditions may affect your Medicare supplement eligibility.

How Pre-Existing Conditions Impact Your Medicare Supplement Eligibility

Medicare supplement plans are offered by private insurance companies. Though Medicare supplement benefits are standardized for each plan letter across the board (meaning AARP can’t offer you additional benefits on a Plan F from Blue Cross Blue Shield – they are required to offer the exact same benefits), insurance companies charge different premiums for the same coverage.

Because of this, it is always in your best interest to shop the market and compare rates from multiple companies for your Medicare supplement. If you don’t, you may end up overpaying quite a bit.

Purchasing a Medicare Supplement During Open Enrollment

The best time to buy a Medicare supplement policy is during your Medicare supplement Open Enrollment Period. Under Federal law, this enrollment period lasts for 6 months. It starts on the first day of the month you’re 65 or older and enrolled in Medicare Part B.

You have certain rights if you purchase a Medicare supplement plan within your 6-month Medicare supplement Open Enrollment Period. Medicare supplement insurance companies generally use medical underwriting to decide whether to accept your application. Additionally, they can use underwriting to determine how much to charge you for your policy. However, during your Open Enrollment Period, an insurance company can’t deny you a Medicare supplement policy or charge you a higher premium because of pre-existing conditions. So, during your Open Enrollment Period, you can purchase a supplement regardless of any previous health conditions.

Because of this, we always recommend that you purchase your supplement during your Open Enrollment Period.

Purchasing a Medicare Supplement After Open Enrollment

It gets tricky when you sign up for a Medicare supplement policy after your Medicare supplement Open Enrollment Period. Insurance companies use medical underwriting to decide, based on your medical history, whether or not to accept your application for insurance, whether or not to add a waiting period for pre-existing conditions, and how much to charge you for that insurance.

After your Open Enrollment Period, your company may not accept your application if you don’t meet the underwriting requirements.

With medical underwriting, consumers usually must answer medical questions on an application. Different companies have different underwriting restrictions and guidelines. This means that if you have a pre-existing condition (i.e. diabetes), one insurance company may approve your application while another company denies it. Because of this, you should consider multiple companies when choosing a Medicare supplement. This ensures you’ll have the highest chance of approval.

Will Medicare Supplements Cover My Pre-Existing Conditions?

Under national law, Medicare supplement companies can refuse to cover your prior medical conditions for up to six months. This is the Medicare supplement “pre-existing conditions waiting period.” This applies to any health conditions you were diagnosed with or treated for within six months of the Medicare supplement plan coverage start date.

You can also avoid the waiting period altogether if you have prior creditable coverage for at least six months. Most forms of health coverage count as creditable as long as there is no break in coverage for more than 63 days.

GoMedigap Can Help

Understanding your Medicare supplement eligibility can be confusing, especially if you are outside of your Open Enrollment Period. To ensure eligibility and approval, it is important to begin shopping for your Medicare supplement early. To compare rates from over 30 of the top providers at one time, give us a call at (866) 894-3258. Or, you can view your Medicare supplement rates online. One of our professional agents will be happy to help you find a supplement that meets your needs. We look forward to speaking with you soon.

Compare Your Medicare Supplement Rates Immediately!

2 Replies to “Are You Eligible for a Medigap if You Have Pre-Existing Conditions?”

  1. I currently am enrolled in a medigap policy. I found one of the same plan but with a lower monthly premium and applied for it. I was turned down because I was diagnosed through an MRI about 9 months ago with arthritis in the lower spine and received a couple diagnostic injections to determine if I was a candidate for treatment. I never followed through with the treatment, since the effects were only temporary. For this reason I was denied coverage for the new medigap insurance. Can they do this? And if so, is there a waiting period? Thank you.

    1. Hi Nancy,

      I’m sorry you’re having issues with your Medigap coverage. Different companies have different guidelines and restrictions for Medicare supplement plan approval. Once you are past your Open Enrollment period upon turning 65, the insurance companies do reserve the right to deny coverage.

      However, because there are many companies and they all have unique underwriting guidelines, you may still have a few options. At GoMedigap, our agents represent over 30 of the top-rated Medicare supplement companies. Because of this, they can shop the market for you and find you a plan from a company that gives you the highest rate of acceptance. If you’re interested in shopping the market to find a company that will work with your diagnosis, please call us directly at (866) 894-3258. Or, you can enter your information online to view your Medicare supplement rates from various companies. Upon viewing your rates, one of our agents will be in touch with you shortly.

      We look forward to speaking with you soon!

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