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Medicare: Enrolling In Medigap With A History Of A Serious Medical Condition

If There Is No Open Enrollment That Applies To You

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If there is no open enrollment period that applies to you, a Medigap insurance carrier may:

  • Require proof that you are insurable before accepting you for Medigap coverage. This means that a company can refuse to sell you a Medigap policy because of your health history.
  • Sell you a policy, but impose a waiting period of up to six months for health conditions for which you got medical treatment or advice within the six months before the date that the new Medigap insurance policy took effect.

If the insurer imposes a waiting period, credit must be given against the waiting period for any time spent in a health plan which ended less than 63 days before the Medigap coverage starts. For example, if you had health coverage for three months, and the gap between the two coverages is less than 63 days, the most amount of time Medigap can exclude coverage for an existing condition is 3 months. If you had prior coverage for 6 months or more, there cannot be any pre-existing condition waiting period. For more information, see HIPAA.

NOTE: Consider the alternative of purchasing a Pre-Existing Condition Insurance Plan (PCIP) which makes health coverage available to you if you are a U.S. citizen or reside here legally, you have been denied health insurance because of a pre-existing condition, and you’ve been uninsured for at least six months.  To learn about the availability in your state, premiums and other costs as well as benefits, click here. offsite link


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