Buying a Medigap policy during your Medigap Open Enrollment Cycle is the best choice. This six-month cycle starts on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. Additional Open Enrollment Periods exist in some states, including those for people under the age of 65.
An insurance provider cannot use medical underwriting to determine whether or not to approve the application during this period. Because of the health issues, the insurance provider is unable to do any of the following:
• Refuse to sell you any Medigap policy it provides • Charge you more for a Medigap policy than someone who is well.
• Allows you to wait for coverage to begin (except as explained below)
Although the insurance provider cannot make you wait for your policy to begin, it might be able to make you wait for pre-existing condition coverage.
A pre-existing condition is a health issue that exists before the start date of a new insurance policy. For up to 6 months, your Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems. A "pre-existing illness waiting time" is what it's called.
The Medigap program would cover the pre-existing condition after 6 months.
A pre-existing condition will only be removed from coverage if it was treated or diagnosed within six months of the Medigap policy's start date. This is referred to as the "look-back era."
Note that Original Medicare will cover your illness even though your Medigap policy does not, so you will be liable for the Medicare coinsurance or copayment.
The definitions for the words in blue can be found on pages 49–50.
The Basics of Medigap Insurance
If you buy a Medigap policy during the Medicare Open Enrollment Period and substitute those forms of insurance coverage that qualifies as "creditable coverage," you may prevent or shorten your waiting time for a pre-existing condition.
Any other insurance plan you had recently before applying for a Medigap program is considered prior creditable coverage. When you've had at least 6 months of continuous prior creditable coverage, the Medigap insurance provider can't refuse to cover the pre-existing conditions if you've had at least 6 months of continuous prior creditable coverage.
Many different types of health-care coverage can qualify as creditable coverage for Medigap policies, but only if you haven't had a break in coverage for more than 63 days.
If your prior policy qualifies as creditable coverage for this reason, your Medigap insurance provider will inform you. You may also contact your state's Health Care Assistance Program for more information. (For more information, see pages 47–48.)
The insurance provider cannot use a preexisting condition waiting period if you purchase a Medigap policy because you have a guaranteed problem right (also known as "Medigap protection"). More information on guaranteed issue rights can be found on pages 21–23.
Note: If you're under 65 and have Medicare because of a disability or ESRD, you may not be eligible to buy the Medigap policy you like, or any Medigap policy, until you're 65.
Under federal regulation, insurance providers are not allowed to market Medigap plans to individuals under the age of 65. And if you're under the age of 65, certain states mandate Medigap insurance providers to sell you a policy.