Can Medigap Insurance Be Denied?

Can Medigap Insurance Be Denied?

“Can you be denied Medigap coverage?” This is a question frequently asked by Medicare Beneficiaries. You can apply for Medicare Supplement insurance (Medigap) if you have Original Medicare Part A and Part B. Can Medigap insurance be denied? That is going to depend on your specific situation.

can you be denied medigap coverage during open enrollment?

Medicare Beneficiaries who are in their Initial Open Enrollment Period (the one time only 6 month period when federal law allows you to buy any Medigap policy sold in your state) cannot be declined a Medigap Policy.

If you are out of your Initial Open Enrollment Period, you will have to qualify for a Medigap Plan based upon medical underwriting guidelines — which differ with all insurance companies.  With that said, there are certain situations that allow Medicare Beneficiaries to obtain Medicare Supplement insurance without worry of being declined.

You cannot be declined for Medigap insurance if you have a Guaranteed issue right. In many cases, you have a Guaranteed Issue Right when you have other health insurance coverage that changes, such as, when you lose other health care coverage.

Examples:

I worked with two clients, recently, who had a Guaranteed Issue Right.  

Client #1 was on a Medicare Advantage Plan that went bankrupt.  This meant her plan was leaving Medicare. She had a right to buy a Medigap Plan without worry of being declined.

Client #2 was on a Medicare Advantage Plan and she moved out of the Plan’s Service area.  She had the right to buy a Medigap Plan with peace of mind that she would not be declined.  This was important for Client #2 because she had some health issues and was concerned about medical underwriting.

These are just two examples, but there are more.

See pages 22 and 23 in the Medigap Buyers Guide to see if you qualify for a Guaranteed Issue right.

Why was i denied a Medigap policy when i am over 65 yrs. old?

If you don’t qualify for Guaranteed Issue and you’re no longer in your Initial Open Enrollment Period, you may be wondering if you will be declined for Medigap insurance. The answer depends on a few factors:

1. Underwriting Questions

Can Medigap be denied for pre-existing conditions? Yes, if you don’t qualify for a guaranteed issue or enrollment period. Each insurance company has their own unique set of health questions and underwriting guidelines. This benefits the consumer since each individual’s health is unique.  For example, ABC insurance company may decline coverage if you have rheumatoid arthritis, while XYZ company will offer you a policy.  In addition, some insurance companies look at a 5 year window for stroke while other companies only look back 2 years.  These are just a couple examples of how medical underwriting can vary from one insurance company to the next.

2. Your Health

Being declined for Medigap insurance because of health conditions is unfortunate. The best way to see if you can get a Medigap Policy is by talking to a Medicare Supplement Specialist. We are able to determine if there are companies that meet your unique health situation.

Final thoughts

One final note, you may already have a Medigap Policy in place and you are doing some research. Please don’t be deterred about moving forward and trying to lower your Premium.  I’ve talked to many people who were able to lower their very high premium even though they were wondering, “will I be declined for Medigap insurance?”.