Pre-Existing Condition Clause

[somarco]

Going from memory and have not had coffee, so don't hold me to it.

Pretty sure New Era does not apply p-x on plan F but can/will on other plans.

There is no standard definition of creditable coverage that is universal. Carriers decide what they will consider creditable.

In most cases having Medicare is considered creditable.

Since this person is at the end of their 6 month initial enrollment period I will go out on a limb and say they have both A and B. Even if they had no coverage prior to 65 good chance p-x won't apply. But as indicated earlier, I don't use UHC and have never had a reason to use them. Can't say what they will do but I suppose you could ask them.

 

[germanwine1]

She has had parts A B and D since t65 in May.

 

[goillini52]

She has had parts A B and D since t65 in May.

Well you've got less than 3 weeks to get her written up. so you better get busy. UHC has a 3 month waiting period for pre existing conditions, so I wouldn't use them.

 

[kstein]

Pretty sure uhc views original Medicare as credible. I've written a lot of uhc and never had one denied bc of pre ex. They have came from all varieties of previous insurances and situations also.

Besides, for med sup it probably isn't worth the hassle for most claims to try and determine if it stems from a pre ex anyways.

 

[jacobtn]

New Era puts a 6 mth prex on all apps without prior coverage.

 

[somarco]

I have never had New Era impose p-x on plan F, only on plan G.

Can you tell us if New Era considers Medicare to be creditable coverage?

 

[yogooglethis]

Pretty sure uhc views original Medicare as credible. I've written a lot of uhc and never had one denied bc of pre ex. They have came from all varieties of previous insurances and situations also.

Besides, for med sup it probably isn't worth the hassle for most claims to try and determine if it stems from a pre ex anyways.

credit for prior coverage is established/confirmed by state laws on replacement form. adding a medicare supplement to original medicare is not replacing anything

I would like to know what other agents tell clients who are facing a waiting period because of no prior coverage when they ask " will policy pay the 20% consultation cost share in the waiting period for my doctor that monitors my HPB,Diabetes etc.?"


To be safe I tell clients it wont be covered even though I have never seen a med supp carrier not pay the 20% for a consultation in the waiting period.

 

[jacobtn]

I have never had New Era impose p-x on plan F, only on plan G.

Can you tell us if New Era considers Medicare to be creditable coverage?

They have stamped the policy schedule page of my plan F sales with the pre x clause. Maybe it is state by state? Not sure why that would matter. They were all Open Enrollment cases where they had no prior health coverage. They told me if they have group or individual health coverage that they would waive it.

They didn't mention Medicare as creditable coverage.

 

[smokin goose]

They have stamped the policy schedule page of my plan F sales with the pre x clause. Maybe it is state by state? Not sure why that would matter. They were all Open Enrollment cases where they had no prior health coverage. They told me if they have group or individual health coverage that they would waive it. They didn't mention Medicare as creditable coverage.

Good to know. Thanks.

 

[somarco]

credit for prior coverage is established/confirmed by state laws on replacement form. adding a medicare supplement to original medicare is not replacing anything

Care to cite the statute that defines creditable coverage?