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Medicare Credible Coverage

Jun 14, 2012

For under 65 disabled, is part A and B considered creditabale converage in case one needs to get a HIPAA policy (ie declared not disabled?

Response from Mr. Chambers

Not really.

Both Medicare and Medicaid are considered Creditable Coverage under HIPAA, but ONLY for crediting pre-existing conditions conditions limitations under a new plan.

However, creditable coverage towards being eligible for a guaranteed issue plan under HIPAA requires: (1) 18 months of coverage with no break longer than 63 days; (2) ; (3) at least the last day of which was under a group health plan. The law defines "group health plan" to be an employer provided plan that falls under the federal ERISA employe benefit welfare law. Medicare and Medicaid to no fit that definition.

To avoid health insurance that requires medical underwriting, the best way to get coverage should you be declared no longer disabled under SSD/Medicare, you would need to find work that provides group coverage. Then the Medicare could erase any waiting period the new plan requires due to a Pre-Existing Conditions Limitations Provision.

Good luck, Jacques

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