2025 Medicare Preexisting Condition Waiting Periods and Costs Explained

In 2024, Original Medicare (Parts A and B) and Medicare Advantage (Part C) plans cannot deny you coverage based on preexisting medical conditions. Unlike these plans, Medigap (Medicare Supplement) plans offered by private insurers may impose waiting periods related to preexisting conditions.

Original Medicare and Part D drug plans do not have any waiting periods for preexisting conditions, ensuring immediate coverage. However, enrollment in Medigap plans can involve specific waiting periods, especially if you apply outside your initial enrollment window.

Understanding the Medigap Preexisting Condition Waiting Period in 2024

Medigap plans help cover costs that Original Medicare does not, such as deductibles and copayments. Since these plans are sold by private companies and do not meet the Affordable Care Act's minimum essential coverage requirements, insurers can apply medical underwriting and waiting periods based on your health history.

When you first become eligible for Medicare at age 65 and enroll in Part B, you receive a 6-month Medigap open enrollment period. During this time, insurers must accept your application without considering preexisting conditions, allowing you to select any Medigap plan freely.

After this 6-month window, insurers may impose higher premiums or deny coverage due to preexisting conditions. If you qualify for Medicare due to disability before age 65, Medigap protections typically begin only once you turn 65.

When Can Medigap Insurers Deny Coverage for Preexisting Conditions?

Outside the initial 6-month enrollment period, Medigap insurers can refuse coverage based on preexisting conditions. However, federal laws provide certain "guaranteed issue rights" that protect you from denial under specific circumstances, including:

• Loss of your Medicare Advantage plan due to plan changes or moving out of the service area.
• Ending of employer or union coverage that supplements Medicare, including COBRA benefits.
• Relocation outside the service area of a Medicare SELECT policy.
• Switching from Medicare Advantage or PACE plans back to Original Medicare within the first year.
• Medigap insurer bankruptcy or involuntary policy cancellation.
• Plan changes due to provider violations or misinformation.

Some states offer additional protections beyond federal guaranteed issue rights.

Switching Medigap Plans with Preexisting Conditions

If you have had a Medigap policy for more than 6 months, you can switch to another plan with the same benefits without facing new waiting periods or exclusions for preexisting conditions. However, switching between different types of Medigap plans may require you to complete a waiting period proportional to the time you had your previous coverage.

For example, if you switch after 2 months of coverage, your new plan may require you to wait an additional 4 months before covering preexisting conditions.

The 12-Month Medicare Advantage Trial Period

Medicare Advantage (Part C) plans must provide coverage equivalent to Original Medicare and cannot deny coverage due to preexisting conditions under the Affordable Care Act. If you switch from Original Medicare and Medigap to a Medicare Advantage plan, you have a 12-month trial period to test the plan.

During this trial, you can return to Original Medicare and reenroll in your previous Medigap plan or choose a new one without medical underwriting or waiting periods.

Key Takeaways for 2024

For 2024, Original Medicare, Medicare Advantage, and Part D plans offer immediate coverage regardless of preexisting conditions, thanks to ACA protections. Medigap plans, however, may still require waiting periods or impose restrictions outside initial enrollment periods.

Understanding your enrollment windows, guaranteed rights, and trial periods can help you avoid coverage gaps or higher costs due to preexisting conditions.

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