Med supp pre-existing conditions

[ValeRosso]

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

Yep this is paragraph solves it:
“If you do have a medical condition that existed within the six-month period before you purchased your Medigap policy, this condition may not be covered during the first six months of your coverage unless you had prior creditable coverage such as group health insurance, individual health insurance, Medicare or Medical Assistance.“

Humana did finally get back to me today and described the exact same thing, if you have prior “creditable coverage” they cannot deny pre-existing conditions.

Thanks for your help with this!

 

[Todd King]

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)

Feds have their minimum, but the states and/or the companies can make a law/rule that covers pre-existing. For example, there are companies that will automatically cover it and then there are states, like South Carolina for instance, that will not allow any company to impose a pre-existing clause, meaning SC demands that they cover it.

 

[yorkriver1]

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)

Of course there is the option for someone on an MA/MAPD plan who moves out of their service area to qualify for a GI MedSupp. Have done one of those. Another move in client who could have had a GI supp just chose to stay on an MAPD PPO in the new state.