My husband is 70 and has been continuously insured under my employer’s plan since he turned 65, so he doesn’t have Part B yet, but he has Part A. I’m retiring in May, and he’ll be moving onto traditional Medicare in April. We already have the CMS form confirming Creditable Coverage with my HR, and they’re taking care of it.
He has Crohn’s Disease and gets infusions every 6 weeks. These are covered under our current plan, and since they’re administered in a hospital, they’ll be covered under Part B. We’re planning to get a Medigap plan, likely Plan G, but I’m worried about whether a Medigap plan will cover the 20% copay for his infusions right away or if there’s a waiting period because it’s a pre-existing condition.
I read something that said, “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.” Does this mean that, since he has had creditable coverage, he’s not going to be subject to that waiting period? We’re in California, in case that matters.
As long as he’s had continuous creditable coverage and there’s no gap between when he joins the Medigap plan and the end of your employer plan, he shouldn’t have to worry about a waiting period for his pre-existing condition.
Also, in many states, Parts A and B are considered creditable during the Medigap open enrollment period, meaning he’s likely safe even if there’s a short gap. I’m not 100% sure about California, but it’s best to check just in case.
@Zeke
My understanding is that guaranteed issue periods prohibit excluding coverage for pre-existing conditions. Someone just turning 65 wouldn’t need creditable coverage to avoid issues with pre-existing conditions.