Jun 032013
 

Seniors contemplating the purchase of a Medicare supplement plan often raise the question pre-existing conditions. Here are some basic facts concerning Medigap coverage of pre-existing conditions.

First let’s define a pre-existing condition. A pre-existing condition is simply a health problem that a person has before their Medicare supplement plan starts.

When a person first purchases a Medigap plan the Medicare supplemental insurance company can refuse to cover pre-existing conditions for up to six months if that person did not previous have credible coverage. Furthermore more, the pre-existing conditions must have been diagnosed or treated during the six months before the policy started.

A person can use creditable coverage to shorten or eliminate any waiting for pre-existing coverage. The time a person has creditable coverage will be subtracted from the waiting period. The time counted as creditable coverage only counts from the last break in continuous coverage that is less than 64 days.

Creditable coverage is any health coverage to include:

  • A health insurance plan
  • Employee group health plan
  • Medicare Part A or Medicare Part B
  • Medicaid
  • A state health benefits risk pool
  • A Federal Employees Health Benefit Plan
  • A health plan under the Peace Corps
  • Health care program for military dependents and retirees

An example of Medicare supplement creditable coverage
Johnny is 65 and has XYZ disease. His Medicare Part A and Part B started 1 May 2013. Before 1 May Johnny had no health insurance coverage. In July of 2013 Johnny decides to purchase a Medicare supplemental insurance plan. His Medicare supplement insurance company does not have to cover his XYZ disease treatments for six months (the pre-existing condition waiting period). But, because Johnny had Medicare Part A and Part B from 1 May to July the insurance company must use his two months of coverage by Medicare as creditable coverage and shorten the six-month waiting period. Now his waiting period will only be four months instead of six months. During these four months Johnny will have to pay any medical costs not covered by Medicare Part A and Part B for any treatments concerning his XYZ disease.

Reference: http://www.medicare.gov/medigap/prex.asp

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