Can You Be Denied a Medicare Supplement Plan?

Medigap plans come in ten variations (A, B, C, D, F, G, K, L, M, &N). Each plan comes with a different level of coverage for the out-of-pocket expenses left behind by your Original Medicare Parts A & B policies. As a senior, you need better predictability in your annual healthcare expenses for optimal financial planning.

If you’re living on a fixed income, you can’t afford to be stuck with a huge hospital or medical bill you can’t afford to pay. Medigap policies cover you for this event, ensuring you don’t have any unforeseen healthcare expenses during the year requiring you to dip into your retirement savings.

Can you be denied a Medicare supplement plan?

In some cases, the insurer might deny your application. However, you can mitigate this risk by understanding the open enrollment period and guaranteed issue rights for Medigap policies.
 

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As mentioned, the ten Medigap plans come with different levels of coverage. The CMS, a Federal agency, regulates the industry. This organization ensures that all Medigap providers offer the same standardized Part A & B benefits in their Medigap plans.

All Medigap plans offer the following benefits.

• Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
• Part A hospice care coinsurance or copayment.
• Part B coinsurance or copayment.
• Blood transfusion costs for the first three pints of blood.

Plans F, G, and N offer additional Medicare Parts A & B benefits.

• Part A deductible.
• Part B excess charges (Plan N doesn’t cover these charges).
• Skilled nursing facility care coinsurance.
• 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).

The open enrollment period for Medigap starts on your 65th birthday and lasts for six months from that date. If you apply for a Medigap plan during this time, the insurer cannot deny you coverage, even if you have pre-existing conditions like high blood pressure or diabetes.

The open enrollment period only comes around once. You’ll have to notify the insurer if you have a pre-existing condition, but they can’t deny you a plan, and they can’t increase your rates above the average premium.

If you have a pre-existing condition, the insurer can ask you to endure a “waiting period” lasting three to six months.

However, suppose you’ve had at least six months of “creditable coverage” with another healthcare plan, such as an employer plan, union plan, Medicare Part A or Part B, or Medicaid. In that case, the insurer cannot institute this waiting period and must provide our benefits immediately.

If you miss the open enrollment period, the insurer requires you to undergo medical underwriting. They’ll ask you to disclose your pre-existing conditions and health status, and you’ll need to get approved. If they decide you are high-risk to insure, they may deny you coverage.

Outside the open enrollment period, in some cases, you might have “guaranteed issue rights,” where you cannot be denied a Medigap plan. Some examples of guaranteed issue rights are the following.

• Your Medigap insurance company goes bankrupt or moves out of your service area.
• You have a Medicare Advantage plan and decide to switch to Medigap within the first year of coverage.
• Your Medicare Advantage provider withdraws from your area.
• You move to a new area not covered by your provider.
• Your Medigap or Medicare Advantage insurance company broke the rules or misled you.

Some states have additional guaranteed issue rights, extending consumer protections. For instance, Connecticut and New York require insurers to accept Medigap applications anytime during the year.

As mentioned, the insurance company cannot deny you coverage during the open enrollment period. Even if you have a pre-existing health condition, whether acute or chronic, the insurer must accept your application to join its scheme.

However, if you wait for this period to end to join, the insurer may deny you a plan if you have severe pre-existing conditions like chronic lung, heart, or kidney conditions, HIV, AIDS, or cancer.

The insurer usually won’t deny coverage for conditions like high blood pressure or diabetes, but it varies between providers.

If you miss the open enrollment period and apply for a Medigap plan, the insurer may also institute the waiting period, especially if you have pre-existing conditions. Our team can help you find a provider, and we’ll ensure you get the best rate on your monthly premiums.

Any Medicare beneficiary eligible for Medicaid may suspend their Medigap policy for up to 24 months from the eligibility date. During these 24 months, you can reactivate your Medigap plan if you become ineligible for Medicaid.

However, the insurer will see you as a new applicant if you wait longer than the 24-month suspension period to activate your plan. That means they may ask you to undergo medical underwriting, and they might increase your premiums or deny coverage based on its findings.

If you’re interested in joining a Medigap plan, call our office at 1-888-891-0229. Our fully licensed agents offer you a free consultation and quote on any Medigap plan. We work with all the leading insurers, and we’ll get you the best deal on your monthly premiums for any plan.

If you can’t call right now, complete the contact form on our site, and we’ll get in touch with you. Alternatively, you can use the free tool on our site to get an automated quote on any Medigap plan.