Can You Be Denied A Medicare Supplement Plan?

You can be denied a Medicare supplement plan based on when you originally applied.

It’s important to be aware of when you are first eligible for a Medigap policy and how long you will have to enroll in one before you reach a point where you can be denied.

Remember that there are some differences in when you can be denied by each state.

You typically cannot be denied a policy if you are enrolling during your Medigap open enrollment period.

This period lasts for six months and begins the first month that you have Medicare Part B coverage. Even if you have an existing health condition or another extenuating factor, you cannot be denied a Medigap policy at this stage.

Your best bet if you expect to need supplemental insurance is to sign up for it when you first become eligible to avoid any potential issues, gaps in coverage or denials in the future.

Even if you do not currently have a health condition that could lead to you being denied coverage after your initial enrollment period, that may not be the case in the future.

This is the area where you could potentially run into issues when trying to secure a Medigap policy. If you don’t purchase one during your Medigap open enrollment, then insurance companies can choose to reject you for essentially any reason.

The exception to this would be if you experience a qualifying event or a special circumstance that is specified under Medigap protections. This includes scenarios such as if you have Medicare Advantage and you move out of the plan’s area or if you had employer health coverage paired with Original Medicare that is ending.

In these circumstances, an insurance company cannot deny you a Medigap plan regardless of any existing health issues or other scenarios.

For most of the United States, you can be denied a Medicare supplement plan due to pre-existing health issues.

According to the Kaiser Family Foundation, this is true for all but four states. In Connecticut, Maine, Massachusetts and New York, insurance companies must continuously offer Medigap policies to those 65 years or older, or at least offer them for one month out of each year.

But in the rest of the country, an insurance company can choose to deny you based on a health condition. There is no set rule on what health conditions will or won’t lead to a rejection, but things such as heart disease, cancer or other chronic conditions could result in a denial.

Insurance companies that do offer coverage to those with pre-existing conditions can also treat those conditions differently. The company may be able to exclude out-of-pocket costs relating to the health condition for up to the first six months that you are enrolled. After that time frame, your conditions will be covered.

Once you have a policy, it typically must be renewed since it is a guaranteed renewable policy.

But there are some — typically avoidable — reasons that a policy renewal may be denied.

According to the U.S. Centers for Medicare and Medicaid Services, your policy can be terminated if you stop paying your premiums. This can also happen if it is discovered that you lied or gave inaccurate information on your application.

Your renewal may also be denied if the insurance company that provides the policy goes bankrupt or ceases operations.

These situations are largely avoidable as long as you do your due diligence when first applying. Make sure to double check that all of the information you are providing is completely accurate.

You should also be sure that you can afford a Medigap policy before enrolling, since you will lose the policy if you fail to pay your premiums.

If you are denied a supplement plan, the first thing you should do is check your Medicare guaranteed issue rights. You should make sure that the denial was not a mistake or not legal and that none of your rights were infringed upon.

Remember that you cannot be denied a policy if your circumstance meets any of the Medigap protections requirements.

Other than that, there really isn’t much that you can do as far as getting the plan that you wanted. You could look at other Medigap plans provided by other insurance companies and try to apply, but you may run into the same issues especially if you are being denied over a health condition.

Since supplemental insurance is meant to be paired with Original Medicare, you could also look into Medicare Advantage if you are denied. Medicare Advantage plans must include everything that is covered under Original Medicare but often include additional benefits or coverage.

It may be a viable second option if you can’t secure a Medigap policy.