Medicare Supplements and Pre Existing Conditions - Must Watch!
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- เผยแพร่เมื่อ 27 ก.ค. 2018
- www.abtinsuranceagency.com | (888) 465-9728
Do Medigap Plans cover pre existing conditions?
Many people think that Obamacare or the Affordable Care Act did away with all pre existing condition exclusions. And yes, for folks under 65 purchasing individual qualified health plans, there are no longer any health questions or pre existing condition clauses. However, this does not impact Medicare, or Medicare Supplement Plans.
Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Supplement Plans are insurance purchased through private insurance companies to fill in the “gaps” in Parts A and B, and pay the out of pocket costs that Original Medicare doesn’t pay. Medicare Supplement Plans are medically underwritten, meaning the insurance company can ask you a series of health questions to determine if you qualify. Depending on your health, or your height and weight, they could charge you a higher premium, or deny you coverage all together. However, when you’re first getting on to Medicare you have a “Medicare Supplement Open Enrollment Period” - this is a time when you can get any Medigap Plan you’d like, with any company and you are guaranteed to be issued that policy and they can’t charge you a higher rate. This open enrollment period lasts up to 6 months after turning 65 or adding Medicare Part B, and it’s really the best time to buy a Medigap Plan since you’re guaranteed to be issued any plan you’d like.
It’s a common misconception that folks think that the medigap open enrollment period is an annual thing, that every year they can switch their Medigap Plan if they want, with no health questions. But it the majority of states, that is not correct. After you’re initial Medicare Supplement Open enrollment period, you will have to answer health questions in order to qualify for a new or different medicare supplement plan. The Medicare Annual Election Period only applies to Part D Rx plans and Medicare Advantage Plans.
What about pre existing condition waiting periods?
This is from the CMS guide to choosing a Medigap policy: “While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre-existing condition. A pre-existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is called a “pre-existing condition waiting period.” After 6 months, the Medigap policy will cover the pre-existing condition.
Coverage for a pre-existing condition can only be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. This is called the “look-back period." Remember, for Medicare covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t, but you’re responsible for the Medicare coinsurance or copayment. Creditable coverage If you have a pre-existing condition, you buy a Medigap policy during your Medigap Open Enrollment Period, and you’re replacing certain kinds of health coverage that count as “creditable coverage,” it’s possible to avoid or shorten waiting periods for pre-existing conditions. Prior creditable coverage is generally any other health coverage you recently had before applying for a Medigap policy. If you've had at least 6 months of continuous prior creditable coverage, the Medigap insurance company can’t make you wait before it covers your pre-existing conditions. There are many types of health care coverage that may count as creditable coverage for Medigap policies, but they'll only count if you didn’t have a break in coverage for more than 63 days."
So, essentially, as long as you’ve had continuous coverage prior to enrollment, the Medigap Plan cannot place any waiting periods on your pre existing conditions.For folks that are over 65 and they’re looking to save money by switching from one Medigap insurer to another - once you go through the medical underwriting and you’re approved, as long as you’ve had continuous coverage through your old Medigap plan, the new plan cannot place any waiting periods on your pre existing conditions.
Please comment below, or email questions to stephanie@abtinsuranceagency.com
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Excellent, concise explanation. Thanks!
Randy Hamilton thank you for watching!
Thank you. My wife retired 2 years ago with A and B but kept the school district medical plan. We decided to get a G supplement this month to get off the PPO.
We just read our policy and got a little worried. Would we have to pay 100% for a CAT scan, ex-rays, an emergency room visit, and maybe orthopedic surgery?
Thank you so very much for creating this video. I can not wait to show my wife this video.
GREAT explanation. HORRIBLE policies! Absolutely horrible. Only in America.
This excellent information. I hope my PPO is considered "credible coverage " I am 81yr young female who can't deal with this type of inferior coverage. Doctors continuously change and then we have to visit on the computer. I have never seen my 'primary dr. Only a practitioner. I work fairly hard to keep myselfI healthy and deserve better at this point. I don't take meds except Aleve for arthritis. I applied to an insurance company and am awaiting good news.I would appreciate a word of encouragement. Thank you
I turned 70 next year and Stephanie helped me when I was 65 years old and retired and got my 1st supplemental plan they are the best she and her team have taken care of me for almost 4 years now trust her
I like when you get happy!! You light right up!! This is exactly why I want you to represent me and help me make decisions! TY
Thanks so much, Stephanie!
I'll note that Massachusetts is one of the states that does not have medical underwriting and pre-existing conditions when changing from an Advantage plan to a Supplement plan. (This state also has some other unusual Medicare rules, and one side effect is that there are very few Medicare brokers licensed in Massachusetts.)
Thank You so much, it is so scary when changing to a cheaper medical policy and your input was so helpful…🙏
Your videos are really, really good!! Thank you for the great production value and presentations.
You explain things so well. Subscribed
Verlis Guinn thank you, and thanks for watching!
Thank you for sharing very helpful information
EXCELLENT
The term is 'creditable coverage," not "credible coverage." The difference is significant.
Medicare is socialized medicine for seniors.
And what is wrong with that?
@@feartheturtle9618 Absolutely nothing!!!
Stephanie: How do you know if you have a pre existing condition? A friend of mine had bone cancer: They told him he had it for TEN YEARS before he was in so much pain.
My employer offers both advantage and medigap. I believe it’s a transition where there’s no underwriting. I know people who did this with pre existing conditions like cancer.
Employer plans can definitely follow different rules!
Does COBRA, which covered me for 2 years from my job loss to Medicare, count as creditable coverage?
Do you have a video on Credible Coverage? I am currently employed but I am a ridier on my spouse 's Individual Health BCBS plan for the past several years. (spouse is a retired state employee) . I turn 65 in December with pre-existing medical conditions. I applied for Medicare A & B and awaiting for the Medicare card. which is not working well between Medicare and SSA. Can I enroll in BCBS Supplement plan after Dec while still employed and on my spouse's plan?
not sure you're quite correct -- those eligible for medicare while under 65 (on SSDI, in other words) do indeed face increased challenges for supplement plans
That’s right - and we cover that here th-cam.com/video/rse2QMrLk2o/w-d-xo.html
Love your videos, Stephanie! One tip: Creditable Coverage is the term, not credible coverage. I learned this studying HIPAA in 1996-1997.
Yes, I’m aware, and I’m also aware that it sounds as if I’m not saying it correctly in this video! 😊
@@AbtInsuranceAgency What a sweet and thoughtful from Jan!! Thanks to you Jan. What does it mean HIPAA? I had NOT ONE CLUE this was so complex!! -smiles-
I have a ppo and am 73 but I do have MS. Can I get a med a gap
Great info, but rather unfortunate that left incomplete without any mention of the birthday rule that applies and affects switching in some states
We have other videos that are state specific and review these types of rules. Hard to fit everything into one video! Thanks for watching
Six-month waiting does not seem to be much of an issue for high blood pressure or Type 2 Diabetes.
If I understand correctly: When signing up for Medicare there is a 6 month window. 3 months prior to your 65th birthday and 3 months after your birthday. But with a Medicare Supplement, a person has 6 months "after" they turn 65 to sign up with no health question? A little confusing.
Yes, it’s confusing. Your get a 7 month “initial enrollment period” window to sign up for Medicare Parts A, B and/or C, D. (3 months before your birth month, your birth month and up to three months after the month you turn 65).
Additionally, you get a 6 month window to sign up for a Medicare Supplement Plan, this lasts up to 6 months from you Part B start date. I hope this helps!
If I enrolled for Medicare Plan N thru a different broker but wanted to change my broker to Abt Agency, because of your excellent customer service, would I have to go though underwriting even if I am staying with the same plan and the same insurance company ??
Unfortunately once you enroll in a Medigap plan you typically cannot change the broker on your policy without either changing your plan or your insurance carrier. I hope this helps!
@@AbtInsuranceAgency Thank you for your response. I will be sending some questions via email this week regarding selecting my wife's new Medigap Plan. She will be turning 65 in June with pre-existing Type 1 diabetes.
what about insulin pumps, insulin, and continuous glucose monitor what pays those?
Kathy Moore durible medical equipment like what you mention above is typically covered by Medicare Part B.
I have had a medical advantage plan for over the 6 months period this year and had breast cancer. I want to switch to Medicare plus supplement during open enrollment. Can I qualify?
This depends on your situation. Please contact us at 888-465-9728 for more information!
I'm turning 65 in June and have signed up for Medicare A and B and a medigap policy by AARP United health, They are telling me that any preexisting conditions will not be covered for 3 months. I have 45 years of continuous creditable insurance. Can they legally preclude preexisting conditions when you are signing up for your initial enrollment and you have continuous coverage? I can't believe this is possible. No one seems to have the answer and I really don't want to risk going 3 months without coverage. I live in California.
That seems very strange, but ultimately it's up to the insurance company -- I would call them and reference this document: www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf. "While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre‑existing condition. A pre‑existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out‑of‑pocket costs for these pre‑existing health problems for up to 6 months. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover the pre‑existing condition. Coverage for a pre‑existing condition can only be excluded if the condition was treated or diagnosed within 6 months before your Medigap policy coverage starts. T his is called the “look‑back period.” Remember, for Medicare‑covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t, but you’re responsible for the Medicare coinsurance or copayment."
Thank you for responding. After many calls to the insurance company and other agencies, today I received a document from AARP United Health with a rider to disregard the first document and that all preexisting conditions will be covered from day one with no look back period. Apparently, I was right. According to the document they sent, in the state of California, I have a guaranteed issue right during the period just before and after turning 65 during initial Medicare enrollment. Surprisingly, no one I spoke to seemed to know this except the California insurance commissioner's office that recommended I file a complaint, which I was just about to do.
So if I am turning 65 in February, 2021 then I have until August 2021 to enroll in a Medigap supplement policy? I thought the window was three months before the month one turned 65 and the expiration time was three months after the month one turns 65.
Yes correct - you have up to 6 months after your Part B effective date to enroll in a Medigap/Medicare Supplement plan without medical underwriting!
What if you are turning 65 and switch from medicare advantage to a medicare supplement? Is that creditable coverage?
In general, yes!
One thing you didn’t cover is renewing a supplement. Turned 65 last year and got a supplement with Aetna. Will I need to qualify if I want to stay with them? I’m in AZ, if that matters. Got it thru a company in TX which have turned out to be total scumbags. Do I have to renew thru them if I want to keep the same policy, if available? Aetna has been okay, zero interest in dealing with the agent ever again.
Medicare Supplement Plan auto-renew every month. No action required, and your plan is guaranteed renewable for life. I hope this helps!
How do you get pre-qualified by supplement?
You have to apply to see if you can pass through underwriting. But our agents can help determine which carrier will and will not accept you based on your medical conditions. Please give us a call!
You didn't bring up Special Elections and Medigap guarantee issue, 99% of people have no clue about that. Last year dad and I had 7 clients on a $72 a month PPO get termination letters from the insurance company that their plans were going to be discontinued at the end of the year, we put 5 of those 7 on HDF Med Supplement plans. We also had 3 clients move out of state to live closer to their kids, 2 went into states where we had non-res licenses and we put them on HDF Med Supps and the other client we told them what they needed to do once they moved back to Tennessee (we're not licensed there)
Oh that's so good. Happy you let me know some pretty good news! I only hear the bad news
I guess that's the way some people are. Thx again!
I sent you a message well over a week ago but never received any response? I have no preexisting conditions and wanted to switch off medicare advantage to Medicare classic, I am 69. I’m sorry I never heard from you.
I’d appreciate knowing why before I seek help elsewhere, if at all possible? Thank you.
Please email me directly at stephanie@abtinsuranceagency.com - we can definitely try to help!
medicare enrollment period last 6 months AFTER turning 65 years old.. don't you mean last 3 month AFTER turning 65 years old? (6 month is 3 month before and 3 month after your birth month)
No, the Medicare Supplement Open Enrollment is up to a full 6 months after your 65th birth month or your Part B effective date.
ohh so.. 3 months before and 3 months after (7 months) is open enrollment for medicare Part A when a person turns 65 years old.. right?
러브 쿡Love Cook the 7 month window (three months before and three months after the month you turn 65) is for Medicare Parts A, B, C and/or D.
@@AbtInsuranceAgency thank you so much for explaining..this medicare stuff is confusing 😬 After I do some more research I make sure to call u!
I feel like if I am in a Zoom meeting.
I’m 62 disabled trying to get part B with a prexsisting problem. I have part A Can I get insurance?
Yes! And it is highly recommended to start with a medigap policy. Once your part B starts, the insurance company will have to accept you no matter what health condition. The only reason you should vouch for mapd is if and only if you can't afford the monthly premium.
I would disagree with Stefan. Medigap policies are incredibly expensive under age 65. It's not unreasonable to expect to pay $200+ per month, on top of your Medicare monthly premium. With the average SSDI payment of $1800 and SSI payment of $750, it's really difficult to pay a 6th of your income to health insurance. That being said, if you can afford it, it's could be a good option.
There's also a second consideration. When you turn 65, you have a second Medigap open enrollment period. Your payment under this period is drastically reduced as you no longer fall under the "Disability" criteria.
Finally, there's also a consideration of if you qualify for Medicaid in addition to Medicare. If you qualify for full Medicaid benefits, a D-SNP MA plan would offer more benefits and cover all healthcare costs.
Under 65 Medicare can be complicated. It's important to work with someone that is experienced in private insurance, Medicaid, and Medicare.
@@travisprice5997 Started Medicare under 65 with cancer. When I turn 65 and have that second medigap open enrollment period, is there medical underwriting/health questions I have to qualify for?
She is saying "Credible" coverage.........she means to say "Creditable" coverage. Those are two different words.
So people over 65 will be Underwritten?? Your last video states differently.
Only 1st year...then yearly You will be underwritten. Yes?? Companies will review EACH year!! Make that clear. People will get dropped or not renew if YOU have pre-existing condition. Bye bye! Be straight forward. Waiting periods...now you are getting confusing.
I’m sorry if you find the video confusing. Usually my feedback is that we help to clarify the Medicare confusion.
Your Medigap plan is always guaranteed renewable, for life. Your company can never “drop you” due to your health, etc. However, if you are no longer new to Medicare Part B, and you wish to buy a Medigap plan for the first time or to change your Medigap plan then typically you will be medically underwritten and the insurance company could deny you based on pre existing conditions.