What is the waiting period for a pre-existing condition under a Medicare?
Asked by: Dr. Marques Hettinger II | Last update: September 26, 2025Score: 4.3/5 (16 votes)
Is there a waiting period for pre-existing conditions with Medicare?
Under federal law, Medigap insurers may impose a waiting period of up to six months to cover services related to pre-existing conditions if the applicant did not have at least six months of prior continuous creditable coverage.
What is the 6 month rule for Medicare?
You can sign up for Part A any time after you turn 65. Your Part A coverage starts 6 months back from when you sign up or when you apply for benefits from Social Security (or the Railroad Retirement Board). Coverage can't start earlier than the month you turned 65.
What is the 12 month waiting period for pre-existing conditions?
12-months Condition Specific Waiting Period – this is a period during which a member is not entitled to claim benefits in respect of a condition for which medical ad- vice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which an application for membership was ...
What is the usual minimum waiting period for a pre-existing condition?
The length of time before the start date of coverage during which a condition would be considered pre-existing varies, and can be anywhere from 30 days to 6 months or longer.
Medicare Supplements and Pre Existing Conditions - Must Watch!
How soon after getting insurance can you use it?
Usually, this waiting period is a minimum of 30 days.
How far back is a pre-existing condition?
A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.
What is the maximum time period that pre-existing conditions can be?
The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.
What is the waiting period for pre-existing conditions?
What is the Waiting Period for Pre-Existing Conditions? Under the Private Health Insurance Act 2007, a health insurer may impose a 12 month waiting period on benefits for hospital treatment for pre-existing conditions.
Does Canadian healthcare cover pre-existing conditions?
Health insurance for visitors to Canada typically limits coverage for pre-existing conditions. This means any related medical expenses might not be covered. Many insurance companies may offer coverage for pre-existing conditions as long the applicant meets the criteria set by them.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
Why do you have to wait 2 years for Medicare?
The original purposes of the 24month waiting period were to limit costs to the Medicare trust funds at a time when many workers might have other health insurance coverage and to ensure that Medicare protection is extended only to persons whose disabilities are severe and long lasting.
What is the 90 day rule for Medicare?
A patient having hospital insurance coverage is entitled, subject to the inpatient deductible and coinsurance requirements, to have payment made on his/her behalf for up to 90 days of covered inpatient hospital services in each benefit period.
What is the waiting period for pre-existing disease?
Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 3 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 2 to 3 successful years with the insurer.
Can Medicare refuse to cover pre-existing conditions?
Yes. Medicare Advantage (MA) plans won't reject your enrollment if you have a preexisting condition.
How far back do insurance companies look for pre-existing conditions?
To determine if a condition is pre-existing, insurers examine medical history, treatment records, and diagnosis reports. They may use “look-back periods,” which are specific timeframes—typically six months to a year before coverage begins—to review medical history.
What pre-existing conditions are not covered?
Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.
Can waiting periods be waived?
Sometimes insurers will waive some waiting periods as part of a promotion to attract new members. Usually, they only waive some of the waiting periods for general treatment services. Always check which waiting periods will still apply.
What is a pre-existing condition limitation?
Pre-existing Condition Exclusion. A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan.
What are the most common pre-existing conditions?
Pre-existing conditions were based on a modified version of the Kaiser Family Foundation (KFF) list of common “declinable medical conditions” maintained by more than half of insurers,3 which included HIV/AIDS; lupus; alcohol and drug abuse (excludes tobacco use); mental disorders (eg, depression, bipolar disorder); ...
What is the waiting period for a pre-existing condition under a Medicare supplement?
Be aware that under federal law, Medigap policy insurers can refuse to cover your prior medical conditions for the first six months. A prior or pre-existing condition is a condition or illness you were diagnosed with or were treated for before new health care coverage began.
What does 12 months for pre-existing mean?
What does this mean for me? If your condition has been deemed as pre-existing by our medical practitioner, you'll need to serve the 12-month waiting period (or the remaining part of the period if you have served some of it with your previous fund) before you can claim for the service or treatment.
What is a pre-existing look back period?
Most travel insurance providers impose a lookback period to verify if a claim is relating to a pre-existing medical condition. A lookback period is a time-frame, which typically ranges from 60-180 days, in which a provider can review your medical records and history.
Is high cholesterol considered a pre-existing condition?
Does high cholesterol count as a pre-existing medical condition? Yes. High cholesterol is considered a pre-existing medical condition by insurance companies, along with similar conditions like high blood pressure.
Is arthritis considered a pre-existing condition?
There are a number of other common health conditions that also would have qualified as a pre-existing condition. Pregnancy is classified as a pre-existing condition. Eating disorders are also pre-existing conditions, as is arthritis and even having had a knee replacement.