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Can You Be Denied a Medicare Supplement Plan?


Medicare Supplement plans are a great option for Medicare beneficiaries who want to keep the freedoms of Original Medicare but wish to reduce their out-of-pocket costs. 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.

Medicare Supplement Enrollment

When you become eligible for Medicare Part A and Medicare Part B, you also become eligible for a Medicare Supplement plan. Your Medicare Supplement Open Enrollment Period allows you a six-month timeframe 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 are still eligible to 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.

Medicare Supplement Pre-Existing Conditions

Pre-existing conditions are the main reason you could be denied a Medicare Supplement plan. However, not every carrier has the same rules when it comes to 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.

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

Examples of pre-existing conditions 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.

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Denial of Medicare Supplement Policy Renewal

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. If you lie on your application, fail to pay your monthly premium, or 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 have the right to 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 plan regardless of your health.

FAQs

If I am denied Medigap Plan G can I enroll in Medigap Plan N?
If you are denied for Medicare Supplement Plan G through one carrier, they will also deny you coverage for any other plan letter. However, you may try applying to another carrier.
How do I appeal a Medicare Supplement plan denial?
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.

How to Avoid a Denied Medicare Supplement Plan

Medicare Supplement plan denial can be scary – especially if you are in need of medical coverage. 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.

At MedicareFAQ, our agents work with several top Medicare Supplement carriers to ensure our clients have the best opportunity to enroll in a plan that will accept them. If you believe denial is inevitable for you, you might still have options. We are here to help.

To get started, call us at the number above or complete our online rate comparison form today!

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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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