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.
Most Americans can sign up for Medicare when they turn 65 or meet other requirements, such as having a disability, Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease) or End Stage Renal Disease (ESRD).
One popular type of Medicare insurance plan is a Medicare Supplement plan, commonly known as Medigap. Medigap plans supplement your Medicare coverage by paying for some of your out-of-pocket Medicare costs such as deductibles, coinsurance, copays and more.
While you can apply for or switch Medigap plans any time of the year, the best time to apply is when you have guaranteed issue rights. These rights mean you cannot be denied a Medicare Supplement plan due to your age or health.
If you apply for a Medicare Supplement plan when you don’t have guaranteed issue rights, you could be charged more for a Medigap plan or even be denied enrollment.
Here’s how to avoid being denied coverage.
Apply During Your Medigap Open Enrollment Period
To qualify for a Medigap policy, you must first enroll in Original Medicare, which includes both Medicare Part A and Part B. Once you’re enrolled in Part B and are at least 65 years old, your Medigap Open Enrollment Period (OEP) begins.
Your Medigap Open Enrollment period starts on the first day of the month that you enroll in Part B and are at least 65, and it lasts for six months. During this six-month period, you can’t be denied a Medicare Supplement plan from insurance companies, and they can’t charge higher premium rates due to your health history or pre-existing medical conditions. That means that even those with existing health problems can purchase any Medigap policy that a particular insurance company sells where they live for the same price as people with good health, as long as it is purchased during their Medigap open enrollment period.
It is important to know that your OEP for Medicare supplemental insurance lasts for only six months, and it can’t be repeated or changed. Once your Medigap OEP ends, you won't get another one. There may be other times when you can have guaranteed issue rights, however, which. means you may be able to apply for a Medicare Supplement plan without being denied coverage even if you miss your Medigap OEP.
Apply When You Have Guaranteed Issue Rights
Guaranteed issue rights (also known as Medigap Protections) give individuals certain rights as to when insurance companies must offer them certain Medigap policies. In these situations, an insurance company:
- Must sell you a Medigap policy without using medical underwriting (an evaluation of your current health, health history and pre-existing conditions)
- Can't charge you more for a Medigap policy because of past or present health problems
In many cases, you may have a guaranteed issue right when you have other health coverage that changes in some way, such as losing that coverage or moving to a new location where your current plan isn’t offered.
Some other examples of situations that might qualify you for guaranteed issue rights include but aren’t limited to:
- You drop a Medigap plan or a Medicare Advantage (Medicare Part C) plan because your insurance company misled you or failed to follow federal rules
- Your current Medigap insurance company files for bankruptcy or your plan otherwise ends through no fault of your own
- You dropped a Medigap policy to join a Medicare Advantage plan for the first time and want to switch back within the first year
In some cases, you may have a "trial right" to drop a Medicare Advantage plan and buy a Medigap policy instead. This typically happens if you join a Medicare Advantage plan for the first time and aren’t satisfied with the plan for some reason.
If you apply for Medigap coverage outside your OEP when you don't have guaranteed issue rights, most states allow an insurance company to deny selling you a Medigap policy if you don’t meet their medical underwriting requirements, or they may charge you a higher premium for coverage than you could get if you applied when you had guaranteed issue rights.
According to the Kaiser Family Foundation, 46 states allow insurance companies to deny Medigap coverage to applicants without guaranteed issue rights because of a pre-existing medical condition, such as diabetes or heart disease, except under limited, qualifying circumstances.
This Kaiser Family Foundation analysis of federal law and state regulations found that only four states require Medigap insurers to sell policies to all Medicare beneficiaries ages 65 and older either continuously during the year or for at least one month per year:
- New York
Get Expert Help Applying for a Medicare Supplement 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.