Medicare Supplement Insurance and pre-existing conditions: Windows of coverage

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A pre-existing condition is a health condition that has been diagnosed prior to the beginning coverage date of a healthcare insurance policy. This is no problem for subscribers to Original Medicare, as this typically does not discriminate against those with pre-existing conditions.

However, pre-existing conditions influence the approval of Medicare Supplement Insurance for applicants, as private companies offer the latter. Moreover, state and national laws give private insurers the right to refuse those with pre-existing conditions, and they can decide in-house on the guidelines and other stipulations governing the treatment of applicants with pre-existing conditions.

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On the other hand, there is such a thing as a Medigap Open Enrollment Period, a six-month duration accorded to those who have turned 65 years of age and enrolled in Medicare Part B to subscribe to any Medicare Supplement Insurance of their choosing. During this window, private insurers cannot refuse policies to those with pre-existing conditions. Neither can they demand higher premiums.

While this window is a generous accommodation, private insurers also reserve the right to delay the coverage of pre-existing conditions for six months, in a process known as a “look-back period” or “pre-existing waiting period.” This means policyholders wait before costs for treatment of priorly diagnosed health conditions can be reimbursed.

It is important to be aware of such windows of coverage to adjust expectations and to make the most of Medicare Supplement Insurance.

Delos Yancey III is the president and CEO of State Mutual Insurance, a legal reserve mutual insurer headquartered in Rome, Georgia. For more information on Medicare Supplement Insurance, visit this