I’m new to Medicare and take several Rx for pain, asthma and a few other conditions.

I heard that Part D makes one wait 6 months to a year to get coverage for the medications to cover a pre-existing condition.

So, why should I bother getting coverage?

 

There is no waiting period or pre-existing condition clause for Medicare Parts A Hospital, B Doctor Visits, C Medicare Advantage, or D Rx. See the menu above or site map to learn more

Medicare Supplements does have a 6 month look back period for Pre X, which is CLEARLY stated in the first paragraph on Page 15 of Publication 02110 Choosing a MediGap Policy. However, Medicare Parts A & B will still pay. BUT look at paragraph 5, if you buy during a guaranteed issue period, there is no pre-x!

Since you just got Part B you may have a guaranteed issue period for Part D, see publication # 11219 Medicare C & D enrollment periods. We need to get a copy of your Medicare ID card to verify when, why and how you got Part A & B. More on Part A & B enrollment periods.

I’ve looked at looked and don’t find anything that says exactly that there is no pre – x other than every seminar and training that I’ve ever seen. However, there is NOT a single brochure, policy, evidence of coverage, etc. that says that there is. A pre-existing condition clause would have to be listed in the exclusions and limitations to be enforceable!

Check these links and publications:

CA Health Care Advocates on Part D

Our introductory page on Part D Rx

Medicare’s Guide to Prescription Drug Coverage Publication # 11109

Blue Cross Evidence of Coverage – 124 pages, if this alleged exclusion isn’t here, where could it possibly be?

While every company has limitations on formulary – what Rx they cover and co-pays for different tiers of Rx, that is not a Pre X clause.

Here’s a reply from CA Health Care Advocates

The prohibition against using a pre-existing condition exclusion or waiting period for Medicare Parts A, B, and D is most likely in the Social Security Act that established the Medicare program. Whatever that is would have been applied to Part D when it was enacted if there wasn’t a separate requirement or prohibition. But you are right that it isn’t specifically mentioned as a standard feature. Exclusions or limitations in Medicare Advantage programs probably build on that same concept so it probably isn’t specifically mentioned. I’ve never looked for it because we know companies can’t impose it as a matter of law on A, B or D.

I don’t find a pre-x clause in the law Section 1814 Conditions & Limitations

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