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Does Creditable Coverage Help with Pre-Existing Conditions

Prior creditable coverage is typically any recent health coverage you had before applying for a Medigap Plan. If you have had at least six months of continuous prior creditable coverage, insurers cannot make you wait before pre-existing conditions are covered. Continuous creditable coverage means you did not have a break in coverage for more than 63 days.

If you have had Medicare Part A and/or B for more than six months before you turn 65, you may not have a pre-existing waiting period.

Coverage for a pre-existing condition can be excluded only when such a condition has been diagnosed or treated within six months before the Medigap Plan coverage starts. After that six-month waiting period, a Medigap insurance plan will begin to cover a condition that was previously excluded.

If a Medigap Plan replaces other creditable coverage due to a person becoming eligible for Medicare, the pre-existing condition limitation is reduced by the number of months coverage has been in force.

If you apply for a Medigap Plan when you have a guaranteed right to buy one, insurers cannot make you wait before pre-existing conditions are covered. If you replace a Medigap Plan that you have had for more than six months and the insurer sells you a different Medigap Plan, the insurer cannot include elimination periods, pre-existing conditions, probationary periods or waiting periods. If both plans have the same benefits, the new plan cannot exclude a pre-existing condition.

However, if you replace a Medigap Plan that you have had for less than six months with a different Medigap Plan, the insurer may be able to make you wait for up to six months to get coverage for a pre-existing condition.

When you have had a Medigap Plan for less than six months, the number of months you kept the plan must be subtracted from the waiting period until the new plan covers pre-existing conditions.

When the new plan has a benefit that is different from the previous plan, you may have to wait for up to six months to receive the new benefit regardless of how long you kept the first plan.

NEXT: Guide to Buying Medigap Insurance

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