Med supp pre-existing conditions

[ValeRosso]

Are there any regulations currently for med supp and pre-existing conditions as far as look back periods or waiting periods or anything similar (IE when switching from med supp to med supp) or does every carrier come up with their own rules on this?

For instance, I know Humana will nullify any pre-existing condition clauses if someone was covered by a med supp for at least 6 months prior because they have a 6 month look back.

 

[somarco]

Varies by carrier . . .

At least one carrier imposes a 6 month p-x for IEP enrollees if they did not have prior creditable coverage. P-x usually does not apply to underwritten apps.

I don't write Humana so I am not familiar with their approach.

 

[policywunk]

Are there any regulations currently for med supp and pre-existing conditions as far as look back periods or waiting periods or anything similar (IE when switching from med supp to med supp) or does every carrier come up with their own rules on this?

For instance, I know Humana will nullify any pre-existing condition clauses if someone was covered by a med supp for at least 6 months prior because they have a 6 month look back.

That is determined by state law but i believe it may the same in most states. look on the replacement form for answer for your state.

 

[goillini52]

Are there any regulations currently for med supp and pre-existing conditions as far as look back periods or waiting periods or anything similar (IE when switching from med supp to med supp) or does every carrier come up with their own rules on this?

For instance, I know Humana will nullify any pre-existing condition clauses if someone was covered by a med supp for at least 6 months prior because they have a 6 month look back.

I don't write either one, but it seems like Cigna and New Era work the same way. Don't quote me.

 

[ValeRosso]

Varies by carrier . . .

At least one carrier imposes a 6 month p-x for IEP enrollees if they did not have prior creditable coverage. P-x usually does not apply to underwritten apps.

I don't write Humana so I am not familiar with their approach.

Thank you, I figured it varies but at least in PA it seems like pre-existing does still count for underwritten apps.

 

[ValeRosso]

That is determined by state law but i believe it may the same in most states. look on the replacement form for answer for your state.

Good idea, thank you. Ill see if it details this on the form.

 

[LostDollar]

Are there any regulations currently for med supp and pre-existing conditions as far as look back periods or waiting periods or anything similar (IE when switching from med supp to med supp) or does every carrier come up with their own rules on this?

For instance, I know Humana will nullify any pre-existing condition clauses if someone was covered by a med supp for at least 6 months prior because they have a 6 month look back.

Caveat, NOT an agent.

https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf

See Page 15:

Creditable coverage
It’s possible to avoid or shorten your waiting period for a pre‑existing
condition if:
• You buy a Medigap policy during your 6‑month Medigap Open
Enrollment Period.
• You’re replacing certain kinds of health coverage that counts as “creditable
coverage.”
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 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.
Your Medigap insurance company can tell you if your previous coverage will
count as creditable coverage for this purpose. You can also call your State
Health Insurance Assistance Program (SHIP). (Go to pages 47– 48.)
If you buy a Medigap policy when you have a guaranteed issue right (also
called “Medigap protection”), the insurance company can’t use a pre‑existing
condition waiting period. Go to pages 21–23 for more information about
guaranteed issue rights.

Wouldn't this mean that Federal rules would require a Medigap carrier replacing another Medigap plan that had been in effect for a minimum of 6 months to forgo pre-existing condition exclusions?

 

[rmhaire]

That is determined by state law but i believe it may the same in most states. look on the replacement form for answer for your state.

Actually it's not state but federal. Federal because it's a part of Medicare law. Regulated by CMS.

All med sup carriers have to go by the minimum in the law. Humana make elect to be more liberal as someone posted, but that would be up to the carrier.

Anyone that's outside their OEP is subject to underwriting and a six month waiting period. Possible exceptions would be:
Moving from a MA plan within your first 12 months.
Losing or moving from credible coverage (63 day limit applies)
A month for month allowance for credible coverage (again 63 day max)

 

[goillini52]

As long as they pass UW, there's no waiting period for pre-existing conditions. A few companies like Humana have a waiting period if you had no coverage previously. For example, if you had previously been covered for 3 months, you'd have a 3 month wait with Humana. The way ValeRosso described it in his OP.

 

[somarco]

Thank you, I figured it varies but at least in PA it seems like pre-existing does still count for underwritten apps.

PA does seem to have some odd provisions for Medigap.


People who lose Medicaid during the unwinding of the COVID continuous coverage protections (between April 1, 2023 and April 1, 2024) should now have a new, time-limited opportunity to enroll in a Medigap plan. The PA Bulletin issued on April 22, 2023 notified insurance companies that the Pennsylvania Insurance Department expects them to allow people who lose Medicaid over the next year (called “Medicaid redetermination individuals” in the bulletin) to enroll in a Medigap plan following guaranteed issue requirements. These requirements prevent Medigap insurers from denying someone coverage, charging someone higher premiums based on health conditions, or imposing pre-existing condition coverage exclusions.
https://www.phlp.org/en/news/new-me...nnsylvanians-losing-medicaid-during-unwinding


From the linked PDF . . .

Page 6 -
MEDICAL UNDERWRITING: This means a company considers your medical
history when deciding how much to charge you for insurance

Page 7 describes p-x situations, however it SEEMS to indicate applying p-x is at the carriers discretion.
Make you wait for coverage to start (however, they MAY be able to make you
wait for coverage related to a pre-existing condition).

GI discussed on page 8 & 9 . . . p-x NOT allowed to be excluded

https://www.insurance.pa.gov/Coverage/Documents/Older Pennsylvanians/Medigap4-16.pdf