As a beneficiary of a Medicare PFFS (Private Fee-for-Service) plan, your chances of obtaining supplemental insurance are not assured. Unlike Medicare PPO (Preferred Provider Organization) plans, which are under regulatory watch, PFFS plans are not monitored in the same manner. This could translate into yearly caps on healthcare services and a lack of recourse should issues arise with your insurer. Furthermore, even with a supplemental insurance policy, there’s no certainty that medical providers will honor it. Such uncertainty poses significant risks during urgent healthcare situations that fall outside of your principal coverage. Additionally, should conflicts occur with your PFFS plan provider, don’t anticipate Medicare to intervene—they are exempt from liability for insurer actions.
Denial of Medicare Supplemental Insurance typically stems from health complications at the time of application, particularly if those are deemed preexisting conditions. A “preexisting condition” refers to any health issue that was present before your insurance policy goes into effect, or at any point in the six months leading up to that date. It encompasses conditions that have prompted medical advice, diagnosis, or treatment during those six months. The term extends to conditions related to pregnancy, childbirth, or associated medical issues, as well as any injury or ailment that necessitated medical guidance or treatment within the same timeframe.
