Medicare Supplement Insurance *****
Required provisions (minimum standards)
Medicare supplements and long term care insurance were originally discussed in chapter 21.
With both Medicare supplements and Long-Term Care policies, six months is repeatedly mentioned when discussing preexisting conditions - and you need to remember that time frame.
General concepts: (make sure you understand these)*****
In both cases, the insurance company can look back six months before the application date and if the person received advice or treatment for any preexisting issues then the insurance company can exclude coverage for that issue for up to the first six months of the policy.
The exceptions to the six month exclusion (meaning preexisting issues can not be excluded):
- During Medicare open enrollment (discussed below), and
- When replacing long term care policies, if there's less than sex months between the first and second policy then the new company can not impose a new six-month exclusion.
******Both Medicare supplements and long term care plans have grace periods and free-look provisions of 30 days. Basically, for these two types of health policies (which are usually purchased by seniors), anything having to do with premiums is 30 days.
More specifically:
If an individual had creditable coverage (such as through group insurance before the person retired) for at least six months before applying for a Medicare supplement, then the insurance company selling the supplement can not exclude any preexisting conditions.
Medicare supplements sold in Florida must do the following:
- The supplement has to have a definition of "Medicare eligible expense" that covers at least as much as Medicare,
- The benefits paid by the supplement have to keep pace with changes to deductible and coinsurance amounts in Medicare, and
- Be written in simplified language, to be easily understood by purchasers.
Open enrollment periods *****
If the individual enrolls in a Medicare supplement during the appropriate open enrollment periods, the insurance company may not exclude coverage for preexisting conditions at all. Recall, though, that to qualify for Medicare in the first place, an individual either needs to be at least 65 or, at any age, have kidney disease or be on SSDI benefits.
However, no matter how one qualifies for Medicare, the trigger that begins the open enrollment period is the same. Once an individual is enrolled in both Medicare A and B, the open enrollment window is opened. During that time, the insurance company is not allowed to exclude coverage for any preexisting conditions. If a person buys the supplement after their open enrollment period is closed, the insurance company will consider the individual's health and may exclude coverage for preexisting conditions for up to the first six months, or possibly not even issue the Medicare supplement.
