South Carolina Life and Health Practice Exam

For how long can an insurer deny coverage for a preexisting condition in a Medicare Supplement policy?

1. 3 months

2. 6 months

3. 12 months

4. No limit

The correct answer is: 6 months

In the context of Medicare Supplement policies, an insurer is allowed to impose a waiting period for coverage of preexisting conditions. This period is limited to six months. During this time, any conditions that were diagnosed or treated by a healthcare professional before the effective date of the coverage can be excluded from benefits. This is intended to balance the needs of the insurer to not cover high-risk conditions that predate the policy with the rights of the insured to receive essential healthcare services. Once this six-month period has passed, the insurer cannot deny coverage for any preexisting conditions, ensuring that beneficiaries can access the benefits they need. This regulation helps provide some stability in the marketplace while still allowing insurers to manage their risk. Understanding this waiting period is crucial for beneficiaries and potential policyholders to ensure they are fully aware of their coverage and rights under a Medicare Supplement plan.