As you are going through products this AEP, you may be caught off guard by seeing the “waiting period for pre-existing conditions” terminology for some products. While companies can’t enforce coverage waiting periods on clients for pre-existing conditions alone, they can enforce waiting periods for pre-existing conditions if they did not have creditable coverage prior to the new product.
Creditable coverage is generally insurance coverage that is considered to be as good as or better than Medicare, but companies do have some discretion in determining what they will accept as creditable. While most companies consider Original Medicare to be creditable, some may not. Most companies do not accept Part A by itself as creditable either. If your client has had no coverage at all, they will also be subject to the pre-existing conditions waiting period if the company has one.
Some examples of commonly accepted creditable coverage are group insurance plans, individual plans, and ACA coverage also known as Obamacare. Your client will need to obtain a termination letter or letter of creditable coverage to avoid the pre-existing conditions waiting period.
As always, check the plan’s underwriting guide to get the details about whether or not they impose a waiting period, how long it lasts, and what they deem as creditable coverage as all companies are different. You can also give us a call at 800.777.9322 if you need any help or have any questions.