Can You Be Denied a Medicare Supplement Plan?
- You typically can’t be denied a Medigap policy if you apply during your Medigap Open Enrollment Period or during another period when you have guaranteed issue rights, even if you have pre-existing health conditions. If you apply outside of those times, you could be denied coverage or charged higher premiums.
More than 12 million Americans are enrolled in a Medicare Supplement plan. But is anyone ever denied coverage?
The answer is yes, your application for a Medicare Supplement plan can be denied in certain situations. Below we’ll walk you through some of the reasons you might be denied coverage as well as how to ensure this won’t happen to you.
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Why Can I be Denied a Medicare Supplement Plan?
An insurance company that is selling Medicare Supplement insurance reserves the right to deny your application for a plan if the company feels that your health makes you too risky to insure. Having a pre-existing condition such as cancer or diabetes can cause your Medigap application to be denied if you don't apply when you have guaranteed issue rights.
Depending on when you apply, an insurance company is also allowed to accept your Medicare Supplement application but charge you a higher rate because of your health condition.
There is a specific period of time, however, when Medicare Supplement insurance companies are not allowed to deny you coverage or charge you a higher rate for your plan.
When Can I Be Turned Down for a Medicare Supplement Plan?
You may only be denied a Medicare Supplement plan if you are applying during a time in which you do not have guaranteed issue rights.
Having guaranteed issue rights means that you are protected from an insurance company denying your application or charging you a higher rate for your plan because of your health.
When you have guaranteed issue rights, insurance companies can't use medical underwriting as part of your Medicare Supplement application. Medical underwriting can include extensive health questions or even a physical exam. If you don't have guaranteed issue rights, a Medicare Supplement insurance company can use underwriting to determine your plan premium or to deny you coverage altogether.
When Do I Have Guaranteed Issue Rights?
You have a six-month period of guaranteed issue rights during your Medigap open enrollment period. This enrollment period begins when you are at least 65 years old and enrolled in both Medicare Part A and Medicare Part B.
During this time, you will be able to apply for any Medigap plan available where you live, and the insurance company selling the plan must offer you a standard rate that applies to all incoming beneficiaries of the same age who are also enrolling during their respective Medigap open enrollment period.
After your Medigap open enrollment period ends, you will lose your guaranteed issue rights and insurance companies may resume the practice of denying your policy application or charging you a higher rate for coverage.
Other Times You May Have Guaranteed Issue Rights
There are some additional times that you may qualify for Medicare Supplement guaranteed issue rights, even after your Medigap open enrollment period has ended. These include:
- Being disenrolled from an insurance plan that served as a secondary payer to Medicare
- Dropping a Medicare Advantage plan within the first year of enrollment after having purchased the plan when you first became eligible for Medicare
- Being enrolled in a Medicare Advantage or Medicare SELECT plan and moving to a new service area
- Being misled by your plan or the acting insurance agent when you enrolled in the policy
- Having your Medigap plan end its contract with Medicare
- Being enrolled in a Medigap plan that committed fraud
If any of the above situations apply, you may be able to enroll in a Medicare Supplement plan for up to 63 days with guaranteed issue rights.
What States Allow You to Change Medicare Supplement Plans Without Underwriting?
You may be required to go through the underwriting process if you are already enrolled in a Medigap plan and want to change to a different plan. Residents of the following states, however, are granted guaranteed issue rights to switch Medigap plans without underwriting:
- California
- Connecticut
- Maine
- Missouri
- New York
- Oregon
- Washington
What Are Some Medicare Supplement Underwriting Eligibility Questions?
Insurance companies can use medical underwriting to determine the insurability of an applicant who does not have guaranteed issue rights. The underwriting process may involve a health questionnaire and/or a physical examination.
Answering “yes” to any of the following may be a reason for an insurer to deny you coverage or charge you a higher rate for your policy. It’s important to note that you can call to speak with a licensed insurance agent who can help you determine your eligibility, and you may still qualify for a Medicare Supplement plan even if you have one of the following conditions.
- Cancer
- AIDS
- Advanced diabetes
- Congestive heart failure
- ALS (Lou Gehrig’s disease)
- Alzheimer’s or dementia
- Bone marrow or organ transplant
- Multiple sclerosis
- Parkinson’s disease
- Crohn’s disease
- Hepatitis C
- COPD or emphysema
- Kidney failure or cirrhosis of the liver
- Ulcerative colitis
- Psoriatic arthritis
- Diabetic neuropathy
- Peripheral vascular disease
- Bipolar disorder or schizophrenia
- Osteoporosis with a fracture
Can I Get Medicare Supplement Insurance if I’m Under 65?
Only certain states have laws that require insurance companies to sell Medicare Supplement plans to those under age 65. Insurers in all other states may sell Medigap plans to anyone under 65 years old, but they are not required to do so.
Can I Buy a Medicare Supplement Plan at Any Time?
You can apply for and purchase a Medicare Supplement plan at any time, but a Medicare Supplement insurance company does not have to accept your application if you do not have guaranteed issue rights.
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Can I Be Denied Medicare Plan G?
Medigap Plan G is quickly becoming one of the most popular Medicare Supplement plans.1 But you can still be turned down for Plan G – just like any other Medigap plan – if you do not have guaranteed issue rights at the time of your application.
What Can I Do if I’m Denied a Medicare Supplement Plan?
You may have an opportunity to file an appeal with Medicare if you are denied a Medicare Supplement plan. You may also be able to apply for a plan through a different insurance company who might offer you a plan, or you may be able to enroll in a Medicare Advantage (Medicare Part C) plan.
One great way to get help applying for Medicare Supplemental insurance is to speak with a licensed insurance agent. You can call to speak with an agent who can help you compare multiple plans and help you determine the best time to apply. You can also compare plans online for free and apply for a plan if you find one you like that's available in your area.
