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Can You Be Denied a Medicare Supplement Plan?

You can be denied a Medicare Supplement plan, also known as a Medigap plan, for various health-related reasons. While Medicare Supplement plans are an excellent option for beneficiaries who want to keep the freedoms of Original Medicare but wish to reduce their out-of-pocket costs, it doesn’t mean they are always available. When you have a Medicare Supplement (Medigap) plan, you are no longer responsible for all of the costs Original Medicare leaves behind. However, if you do not enroll when you first become eligible, you could be denied Medicare Supplement coverage.

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Many health-related pre-existing conditions can result in a denied Medicare Supplement plan. To be sure you are not denied coverage, it is essential to enroll during your Medicare Supplement Open Enrollment Period. Below, we’ll discuss how to avoid missing out on these supplemental benefits and your options.

Can Medicare Supplement Plans Deny Coverage?

 

A Medicare Supplement plan provider can deny you coverage for any reason. When you become eligible for Medicare Part A and Medicare Part B (Original Medicare), you also become eligible for a Medicare Supplement plan. Unlike Original Medicare, which is provided to you by the federal government, Medigap plans come from private insurance companies.

The best time to enroll in a Medicare Supplement plan is when you’re first eligible. This is known as your Medicare Supplement Open Enrollment Period, a six-month timeframe allowing you the chance to enroll in a Medicare Supplement plan.

This enrollment period begins on the first day of the month your Medicare Part B becomes active. During this time, an insurance carrier cannot deny you coverage for any reason.

Once your six-month Medicare Supplement Open Enrollment Period ends, you can still apply for a Medicare Supplement plan. There are no specific timeframes in which you must apply for a plan if you only have Original Medicare. If you currently have a Medicare Advantage plan and wish to apply for a Medicare Supplement plan, you must have a valid Special Enrollment Period to return to Original Medicare.

After your six-month Medicare Supplement Open Enrollment Period, enrolling in a Medicare Supplement plan becomes tricky. While you are still able to apply at any time, you can also be denied Medicare Supplement coverage at any time for any reason as determined by the insurance carrier.

Can Medigap Deny Coverage for Pre-Existing Conditions?

Pre-existing conditions are the main reason you could be denied a Medigap plan. However, not every carrier has the same rules regarding pre-existing conditions. For example, one carrier may deny you coverage because you had a heart attack ten years ago. Another carrier may accept you because your heart attack was over five years ago. Thus, if one carrier denies you, you may have other options.

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Medicare Supplement denial can come from several pre-existing conditions that can make it difficult for you to enroll in a Medigap plan after your Open Enrollment period.

Common examples of pre-existing conditions that can lead to a Medicare Supplement denial include:

If you currently have or had any of the above conditions, you are at risk of being denied a Medicare Supplement policy. However, this is not an all-encompassing list. The only way to know for sure is to speak with a licensed agent to review your options.

Your Medicare Supplement Policy Is Guaranteed Renewable (In Most Cases)

For the most part, Medicare Supplement policies are guaranteed renewal. This means as long as you pay the monthly premium, you cannot be denied coverage once you enroll in a plan, regardless of any health conditions that may arise.

There are very few circumstances when your carrier may drop your coverage after you enroll in a Medicare Supplement plan. This includes lying on your application, failing to pay your monthly premium, or, if your Medicare Supplement plan carrier goes bankrupt, you will lose coverage.

If you fail to pay your premium or lie on the application, you will not have a guaranteed issue right to enroll in another Medicare Supplement plan. Thus, if you apply to another carrier, they can deny you coverage. On the other hand, if you lose coverage due to your plan going bankrupt, you will receive guaranteed issue rights to enroll in another Medigap plan regardless of your health.

FAQs

Can You Be Denied Medigap Coverage for a Medigap Plan and Enroll in Another?
If you are denied a Medigap plan through one carrier, they will also likely deny you coverage for any other plan letter. However, you may try applying to another carrier. It’s best to speak with a licensed agent who can compare carriers and find the right coverage for your needs.
How Do I Appeal Medicare Supplement Denial of Coverage?
Filing your appeal is simple. Call 1-800-MEDICARE (1-800-633-4227) or 1-877-486-2048 if you are a teletypewriter (TTY) user. If you believe you were wrongfully denied Medicare Supplement coverage, you can request a copy of your medical records. This will provide a reason for denial from the carrier you applied with. If there is an error on your medical records, you may have it corrected by your physician and apply again.
Can Medigap charge more for pre-existing conditions?
Yes, if you have pre-existing conditions but are not denied a Medicare Supplement plan, the carrier may still charge higher premiums due to your health status. This is one more reason that signing up as soon as you are eligible is the best option for beneficiaries, as it helps save money on the cost of your benefits.

How To Avoid Medicare Supplement Denial

Undergoing a Medicare Supplement plan denial can leave you in a bad place. Beneficiaries depend on their benefits to help cover their healthcare costs, and the uncertainty can be a shocking, unpleasant experience. Fortunately, you have options.

If you think you may be denied Medigap coverage, it is best to reach out to a licensed agent with knowledge of the plans available in your area. Here at MedicareFAQ, our agents can help!

Our team works with several top Medicare Supplement carriers and can help you find the best opportunity to enroll in a plan that will accept you. If you believe you’re facing a Medicare Supplement denial or have already been denied coverage, you might still have options, and we’re here to help. To get started, call us at the number above or complete our online rate comparison form today!

David Haass

David Haass

David Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council and stay up-to-date with the latest Medicare trends and changes. He holds a Bachelor of Science in Business Administration and Management from the University of Florida.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

2 thoughts on "Can You Be Denied a Medicare Supplement Plan?"

  1. I am 75 and only have Medicare a&b . .Am I going to be able to get a medigap plan now or do I have to wait for open enrollment? I could not afford ins. until now

    1. Maureen, if you only have Medicare Part A and Part B you can apply for a Medicare Supplement plan at any time. Keep in mind, you will need to answer underwriting health questions. So, your health will be the deciding factor in enrollment.

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