Pre-Existing from MAPD to Med Supp

[Chazm]

I've never really had to deal with this, but a colleague asked me today if a client has had a MAPD and switches to a Med supp, does he/she have to wait the 3 months before getting coverage for a pre-existing procedure?
I said as long as the client had coverage for 6 months prior to the Med supp starting, there is no waiting period.

But then he mentioned that he just had a client who had a MAPD for 5 years and then switched to a Med supp, charged for a procedure because it was a pre-existing.

Sooooo I'd figured I'd come here to get that cleared up

 

[vic120]

should not be MAPD is creditable cov,

 

[axeman462]

Page 15 from the "Medigap Buyers Guide":

"When is the bet time to buy a medigap policy?
Coverage for a pre-existing condition can only be excluded in a medigap policy if the condition was treated or diagnosed within 6 months before the date the coverage starts under the Medigap policy. This is called 'the lookback period'. After the 6 month pre existing condition waiting period the medigap policy will cover the condition that was excluded."

 

[somarco]

Look at your applications and underwriting guides. They will address the p-x issue. Seems to vary by carrier and sometimes state.

 

[vic120]

Page 15 from the "Medigap Buyers Guide":

"When is the bet time to buy a medigap policy?
Coverage for a pre-existing condition can only be excluded in a medigap policy if the condition was treated or diagnosed within 6 months before the date the coverage starts under the Medigap policy. This is called 'the lookback period'. After the 6 month pre existing condition waiting period the medigap policy will cover the condition that was excluded."

It also says somewhere that any previous cov that is considered creditable cov must be counted towards that time,

So if a person had not been without creditable cov for 6 months prior there is no waiting period

 

[axeman462]

It also says somewhere that any previous cov that is considered creditable cov must be counted towards that time,

So if a person had not been without creditable cov for 6 months prior there is no waiting period

yes, it says that in the next parqgraph, but it is in reference to Medigap Open Enrollement

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Look at your applications and underwriting guides. They will address the p-x issue. Seems to vary by carrier and sometimes state.

Assuming that Chazm is talking about AARP in FL. He is ok. There are no waiting periods for pre x

 

[vic120]

yes, it says that in the next parqgraph, but it is in reference to Medigap Open Enrollement

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I am not talking about open enrollment I am talking about pre ex there is a 6 month period but any previous cov that was held during the 6 month must be counted towards that 6 month

this has nothing to do with OE

 

[Chazm]

yes, it says that in the next parqgraph, but it is in reference to Medigap Open Enrollement ---------- Assuming that Chazm is talking about AARP in FL. He is ok. There are no waiting periods for pre x

Yeah not in open enrollment. I just had always assumed if you had a MAPD you were ok. Again, I never had an issue but a friend did.

 

[axeman462]

yes, it says that in the next parqgraph, but it is in reference to Medigap Open Enrollement

----------
I am not talking about open enrollment I am talking about pre ex there is a 6 month period but any previous cov that was held during the 6 month must be counted towards that 6 month

this has nothing to do with OE

I dont see that in there, but ok.

 

[vic120]

I dont see that in there, but ok.

Prior creditable coverage is generally
any other health coverage you recently had before
applying for a Medigap policy

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Creditable coverage is provided by any of the following sources:
◦Health insurance coverage
◦Champus and Tricare health care programs for the armed forces
◦A medical care program of the Indian Health Service or of a tribal organization
◦A State health benefits risk pool
◦Federal Employees Health Benefits Program
◦A group health plan
◦Medicare (Credit for this type of coverage is only required if an application is submitted to Medigap in the initial six-month period a beneficiary is both 65 and enrolled in Medicare Part B)
◦Medicaid
◦A public health plan (Any plan established or maintained by a state, the U.S. government, a foreign country, or any political subdivision of a state, the U.S. government, or a foreign country that provides health coverage to individuals who are enrolled in the plan.)
◦A health benefit plan issued under the Peace Corps Act
◦Medicare supplement insurance, Medicare select coverage or Medicare Advantage Plan (Medicare HMO Plan)