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Module 3, Lesson B: Buying a Medigap Policy

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Other Enrollment Considerations

The insurance agent learns that Sondra and Marvin currently have health insurance coverage through an Employer Group Health Plan (EGHP) and expect to keep that coverage until they enroll in Medicare and Medigap.

The agent explains that during the Open Enrollment Period, an insurance company must reduce the preexisting condition waiting period if you have creditable coverage prior to purchasing a Medigap policy.

A preexisting condition is a health problem you had before the date that a new insurance policy starts.

Creditable coverage is previous health coverage (with no breaks in coverage lasting more than 63 days) under one or more of the following:

  • A Group Health Plan (e.g., an employer plan)
  • A health insurance policy
  • Medicare Part A or Part B
  • Medicaid
  • Indian Health Service or a tribal organization
  • A state health benefits risk pool
  • TRICARE for Life (the health program for military dependents and retirees)
  • The Federal Employees Health Benefit Plan (FEHBP)
  • A public health plan
  • A health plan under the Peace Corps Act
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Select Scenario A and Scenario B to see how preexisting condition and creditable coverage play out in two different situations.

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Last Updated 11/02/2004