Can a Medigap insurance company delay coverage of a condition?
Why is the Medigap insurance company delaying coverage of my diabetes? I signed up during my Initial Enrollment Period and thought I had a guaranteed right to coverage.
An insurance company selling Medigap policies cannot deny coverage to a beneficiary applying for a policy during the Initial Enrollment Period. However, it can delay payment if:
- the individual did not have continuous creditable medical coverage for six months before the Medigap policy started, and
- a condition was treated or diagnosed during that time.
Part A and Part B will still cover Medicare's share of the bill but the individual will be responsible for the copayments or coinsurance.
The insurance company must shorten or eliminate the waiting period for coverage if the beneficiary had at least six months of creditable coverage (without a break of more than 63 days) before applying for the Medigap policy.
Last updated: 12-09-2024