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Friday, Oct 24, 2014
Healthcare Exchange Q&A

Will the health law drop pre-existing condition rules from my Medigap policy?

Published:

Q: Right now, I am excluded from buying a Medicare Medigap policy because of a pre-existing condition, from which I have been symptom-free for 35 years. When the Affordable Care Act kicks in, will insurance companies have to accept me? — Barbara from Michigan

A: The Medigap policy you mention is part of Medicare, the government’s health insurance for seniors. Medigap is a form of private insurance you can buy to cover treatments and other costs that original Medicare policy doesn’t cover.

Your query also suggests you are older than 65. If that’s the case, and you are eligible for Medicare, the health insurance exchange is not for you. Medicare operates its own separate program.

Pre-existing conditions are a big deal for people who can shop on the exchange, also known as the online marketplace. The Affordable Care Act says that on the exchange, individuals with pre-existing conditions cannot be charged more than other individuals.

However, the same doesn’t apply to Medicare recipients, specifically those who were uninsured just prior to signing up for Medicare. The National Academy of Elder Law Attorneys says that Medicare has not done the same. Restrictions may continue to apply to certain seniors wanting Medigap policies.

“Thus, Medigap policies will continue to be able to apply such exclusions to people age 65 and older who did not have other insurance for six months before their Medicare eligibility,” the organization wrote in a policy statement.

The elder attorney group opposes this ongoing restriction, but it’s not clear if any concrete efforts are underway to change the law.

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