Because Medicare and Medigap policies are not part of Obamacare, does that mean Medigap insurers can still deny coverage for preexisting conditions?


Answer

Under the ACA neither Original Medicare or Supplemental Medicare (like Medigap) can deny coverage for preexisting conditions. Just make sure to enroll during initial enrollment periods and to switch plans at the correct enrollment and disenrollment periods to avoid any potential barriers to getting coverage (such as late fees for missing enrollment periods).

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John Melling on

In Tennessee supplement I purchased asked preexisting questions three months after I got my policy I had angina.they cleared the Stent and I didtherapy. My insurance was administered by BCBS of tennessee. One day I received a bill for therapy today I got one for hospital. I have talked to farm bureau and bcbs.apparently they decided I have previously existing condition. The question was asked about having a heart attack or stroke in last 5 years. I answered no. Should I hire a lawyer? I had only been to heart doctor annually for the last five years with no new issues

ObamaCareFacts.com on

So major medical can’t ask about preexisting, but supplemental short term or traveler’s can. It’s only the core major medical coverage that protects you from the fee that has to adhere to the new rules. Large groups and grandfathered plans are also excluded from some of the requirements of the PPACA.

Joan Ritchie on

So, how can Humana deny coverage based on a prescription medication my husband is taking? The prescription indicates a heart condition that is managed and under control with the prescription. They denied him last year. They did not want to take the application this year but I insisted. Amazing, they lost the application! So how is Humana getting away with not following the law?

ObamaCareFacts.com on

WOW! That is the sort of thing to report officially. You can appeal insurance company decisions directly or you can resort to other means.

Vishal Mishra on

Does this also apply to Medicare Advantage/Replacement plans

Dr BC on

It is good and explicit reply.

My wife is with Aetna Medicare Advantage. I understand United Health Medicare Supplement is better.

Can She move into it during this enrolment period?

She had diagnosis of cancer tongue. It was removed. She may need followup, her doctor says.

Please help.

erin.georgen@gmail.com Erin on

Medicare has a different enrollment period than the other insurers, but you can make any changes you need to your Medicare coverage during that time. Check out this page for details: https://obamacarefacts.com/medicare/medicare-enrollment/

Cathie King on

This answer is very unclear. I have just applied to Aetna supplimental insurance and because my meds indicate meds for Asthma, I was denied (I did disclose this at application). I am 76 and have had an Advantage plan and now want to add a supplimental plan. I was denied. Your answer is confusing because of the indication that the supplimental should be purchased initially at age 65?

Janis Sayre on

I HAVE JUST BEEN DENIED ACCESS TO A MEDICARE GAP PLAN (PLAN N) BECAUSE OF ONE PARTICULAR MEDICATION I AM PRESCRIBED. IT IS PRESCRIBED FOR A PRE-EXISTING CONDITION. IF I CANNOT BE DENIED FOR A PRE-EXISTING CONDITION, HOW CAN I BE DENIED FOR TAKING THE PARTICULAR MEDICATION.

HOW IS THIS ACTION LEGAL?

ObamaCareFacts.com on

Medigap does have some odd preexisting conditions rules, for example a rule that is dependent on how long you have had the coverage. Without knowing the specifics I don’t exactly know how to respond, but maybe this page will help shed some light on the preexisting conditions rules https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap

” 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 (called the “pre-existing condition waiting period”). After these 6 months, the Medigap policy will cover your pre-existing condition.

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.

When you get Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t cover your out-of-pocket costs, but you’re responsible for the coinsurance or copayment copayment.”