When your health can't be held against you
- Medigap open enrollment: the 6 months starting the first month you are 65 or older and in Part B. A company must sell you any policy it offers and can't charge more for health problems.
- North Carolina's under-65 window: if you have Medicare because of a disability, G.S. 58-54-45 requires at least Plan A (and Plan D or G if sold at 65 and older) "without regard to medical condition, claims experience, or health status" within 6 months of first enrolling in Part B.
- Guaranteed-issue rights: for example, your Medicare Advantage plan ends or leaves your area, or employer coverage that pays after Medicare ends. In these cases the company must cover your pre-existing conditions with no waiting period.
The pre-existing condition waiting period
In open enrollment, a company can delay paying its share for a pre-existing condition for up to 6 months. North Carolina's law sets the outer limits: a policy may not deny a claim for a pre-existing condition incurred more than 6 months after coverage starts, and it may look back no more than 6 months for advice or treatment (G.S. 58-54-10(d)).
You can shorten or skip the wait. If you had at least 6 months of continuous creditable coverage before applying, with no break longer than 63 days, the company can't make you wait at all.
Outside those windows
North Carolina has no birthday rule. If you apply at any other time, the company can use medical underwriting: it may ask about your health, decline you, or charge more. Some people with health conditions do get approved; it depends on the company and the condition.
- Don't drop current coverage first. Apply, get approved, then cancel.
- Answer health questions truthfully. A company can end a policy if your application wasn't truthful.
- Check for a guaranteed-issue right. If your Medicare Advantage plan is ending for 2027, you likely have one; see plans ending in 2027.
To compare Medigap policies from the companies they work with, you can request a call from a licensed insurance agent. More in Medigap in North Carolina.
Related questions
When can I buy Medigap in North Carolina?
Every protected window.
Can I get Medigap under 65 in North Carolina?
The disability window in state law.
Can I switch Medigap plans in North Carolina?
Switching with health conditions.
Sources
- N.C. General Assembly — G.S. 58-54-10, Standards for policy provisions
- N.C. General Assembly — G.S. 58-54-45, By reason of disability
- Medicare.gov — Get ready to buy (Medigap open enrollment)
- CMS — Choosing a Medigap Policy (pre-existing conditions, guaranteed issue rights)
More questions in this guide
- Are Medigap rates based on age in North Carolina?
- Can I get Medigap under 65 in North Carolina?
- Can I switch Medigap plans in North Carolina?
- Does North Carolina have a Medigap birthday rule?
- Medigap Plan G vs. Plan N in North Carolina
- What happens to my Medigap if I move out of North Carolina?
- When can I buy a Medicare Supplement plan in North Carolina?
Part of the guide: Medigap (Medicare Supplement) in North Carolina · All questions
Frequently asked questions
What counts as a pre-existing condition for Medigap in North Carolina?
Under G.S. 58-54-10(d), a policy can't define it more broadly than a condition for which a physician gave medical advice or recommended or provided treatment within the 6 months before your coverage starts.
Does Original Medicare still pay during a waiting period?
Yes. Medicare covers its share of Medicare-covered services for the condition; only the Medigap policy's share can be delayed, so you would owe the usual coinsurance for that condition during the wait.
What is creditable coverage?
Generally other health coverage you had recently, such as employer, union or individual coverage. It counts only if your break in coverage was no more than 63 days. Ask the Medigap company whether yours counts.
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