Can You Be Denied a Medicare Supplement Plan?

You may not be guaranteed Medigap coverage

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Medicare provides hospital insurance (Part A) and medical insurance (Part B) for people 65 or older, or under 65 who have specific disabilities and end-stage renal disease (ESRD). It also provides optional prescription drug coverage (Part D). You can enroll in Medicare when you’re eligible, no matter your health history.

But Medicare, which covers many items and services, does not cover all costs. It has copayments, coinsurance, and deductibles, and often does not pay international medical bills. To limit these expenses, you can sign up for Medicare Supplement Insurance (Medigap). But, depending on when you apply, your application for coverage could be denied.

Learn about the different types of Medigap plans, how to get one—and when you could be denied a Medicare supplement plan.

Key Takeaways

  • Private companies sell Medigap coverage which can be an essential supplement to Original Medicare (Parts A and B). 
  • Medigap coverage is best purchased during your once-per-lifetime Medigap open enrollment period—it starts the first month you have Medicare Part B and are at least 65 years old and lasts for six months.
  • If you don’t purchase Medigap during the open enrollment period or another federal or state-guaranteed issue period and have a preexisting condition, you may be denied coverage or charged higher premiums.
  • Some states offer stronger consumer protections where Medigap policies and purchases are concerned.

What Is Medicare Supplement Insurance?

Medicare Supplement Insurance or Medigap is sold by private insurance companies. You must be enrolled in both Parts A and B to be eligible for a policy. It’s not an option if you have a Medicare Advantage plan, and coverage is for one person only (spouses need to purchase Medigap separately). Typically, Medigap is applied to Medicare-covered services as secondary coverage.  

Medigap policies charge a premium which varies depending on which plan type you get.

Medigap policies vary by 10 plan types. Each is assigned a letter (A, B, C, D, F, G, K, L, M, or N) and coverage varies, depending on which type you get. In general, most Medigap policies fully or partially cover:

  • Part A and B copayments and coinsurance
  • Hospice care copays
  • Preventive care that Original Medicare does not cover
  • Blood
  • Some or all of the Part A deductible
  • Skilled nursing facility care coinsurance

Only some Medigap policies may cover:

  • Part B deductible
  • Part B excess charges
  • Emergency health care coverage while you’re traveling internationally
  • In some states, preventative vision, dental and hearing coverage may be available for an additional cost or included.

Original Medicare doesn’t have out-of-pocket maximums—meaning, there’s no limit to how high your annual expenses can go. Medigap plans K and L limit your annual out-of-pocket costs in 2022 to $6,620 and $3,310, respectively.

Can You Be Denied Medigap Coverage?

The answer is yes, you can be denied Medigap coverage. But you can also be guaranteed Medigap coverage if you apply during your Medigap open enrollment period. 

During the Medigap Open Enrollment Period

You can’t be denied coverage if you apply during your Medigap open enrollment period. It begins the first month you have Part B coverage and are at least 65 years old and lasts for six months. During this once-in-a-lifetime window, insurance companies are not allowed to consider your health or any preexisting conditions when pricing or offering you a policy. In other words, they can’t: 

  • Charge extra for past or present health problems
  • Refuse to sell you a Medigap policy based on age, gender, or health status
  • Delay coverage—unless you have a preexisting condition and haven’t had at least six months of “creditable coverage” prior to applying for Medigap. (The insurance company can only make you wait for coverage related to that condition.)  

Examples of “creditable coverage” to eliminate (or reduce) the preexisting condition waiting period are: A group health plan, such as an employer or union plan, a health insurance policy, Medicare Part A or Part B, and Medicaid. If you don’t have creditable coverage for at least six months, there may be up to a six-month waiting period for the specific preexisting condition.

If you miss the open enrollment period, there is no guarantee that an insurer will sell you a Medigap policy and you may pay more for one. You also may be subject to health screenings after your Medigap open enrollment period ends.

If You Have Certain Health Issues

You can’t be denied or charged more for coverage if you apply during your Medigap open enrollment period. But after that six-month period ends, insurers are allowed to collect information about your health and use it to decide whether to accept or deny your application. Many companies will deny Medigap coverage for conditions such as chronic lung, kidney or heart conditions, AIDS, and cancer. Some companies may consider each case for how acute conditions such as diabetes are for the applicant before making their decision.

Even if an insurer offers you a policy after Medigap open enrollment ends, it may increase your rate due to health issues and attach waiting periods for coverage for preexisting conditions. 

If You’ve Voluntarily Suspended Your Medigap Policy

A Medicare beneficiary who becomes eligible for Medicaid can voluntarily suspend their Medigap policy for a period of up to 24 months. If during these 24-months you become ineligible for Medicaid, your Medigap policy will be reinstituted. However, if your Medigap policy remains suspended for a period greater than 24 months, you may be considered as a new applicant or someone with a lapsed policy. In that case, you’d need to reapply and would likely be subject to medical underwriting, which could lead to a denial of coverage.

Denial of Medigap Policy Renewal

In most cases your renewal is considered guaranteed and cannot be dropped, however there are certain circumstances when the insurance company can decide not to renew your Medigap policy:

  • You stopped making premium payments
  • You lied on your policy application
  • Your insurance company went bankrupt

Medigap policies sold prior to 1992 are not guaranteed renewable, though the insurer needs the state’s permission to drop your coverage. Even then, you have the right to purchase another policy.

How Do You Get Medigap Coverage?

The best time to get Medigap coverage is during your once-per-lifetime Medigap open enrollment period. This period lasts for six months, beginning the first month you are enrolled in Medicare Part B and are at least 65.

Before You Buy Medigap

Here are some things to keep in mind before you purchase your Medigap policy:

  1. You must have Medicare Part A and Part B to be eligible to buy Medigap.
  2. There’s only one Medigap policy per person, spouses need separate policies.
  3. If you buy a Medicare drug plan in addition to Medigap, you will have to make two separate premium payments.
  4. You cannot have drug coverage in both Medigap and a Medicare drug plan.
  5. Medigap premiums can vary for similar coverage, so it's important to compare plan costs before buying.
  6. In some states, you can buy another type of Medigap policy called Medicare SELECT, which requires the use of in-network hospitals or doctors for full coverage. If you purchase Medicare SELECT, you have 12 months to switch back to Medigap if you change your mind. 

Steps for Getting Medigap Coverage

In most states, follow these steps for getting Medigap coverage

  1. Decide on your plan: Compare the different plans and choose the plan that covers what you need. 
  2. Discover policies: Find out which are available in your area, and the companies selling those policies using the Medigap plan finder
  3. Contact the company: Get quotes from different companies selling Medicare Supplement Insurance for the plan you’re interested in buying. You may wish to ask: Do you use medical underwriting for this Medigap policy? Can you tell me if I will likely qualify for the Medigap policy? Do you have a waiting period for preexisting conditions?
  4. Complete the purchase: Fill out your application and pay for your Medigap policy.

At no charge, your state health insurance assistance program (SHIP) can help you choose a Medigap policy.

Medigap Guaranteed Issue Rights

You may qualify for guaranteed issue in specific situations outside the Medigap open enrollment period by federal law. For example, if:

  • You no longer have coverage because your Medigap insurance company went bankrupt 
  • Your employer-sponsored supplemental/retiree coverage is ending
  • Your Medicare Advantage Plan or PACE withdraws from your area, you moved to a new place not covered by your plan, or you chose to withdraw from a plan during the trial period.
  • You choose to drop your Medicare Advantage plan within 12 months of enrolling.
  • You choose to drop your Medigap or Medicare Advantage coverage because your insurance company broke rules or misled you.

Some states go beyond the federal requirements regarding Medigap guaranteed issue rights. For example, states such as New York and Connecticut require insurance companies to accept Medigap applications at any time throughout the year; insurance companies are not allowed to charge more for a policy due to an applicant’s health.

Medigap and Medicare Advantage 

If you have a Medicare Advantage (MA) plan, it’s illegal for an insurance company to sell you a Medigap policy. But if you switch to MA after you’ve purchased a Medigap policy, you’ll probably want to drop your policy since you can’t use it to supplement your MA plan.

If you drop your Medigap plan because you enrolled in Medicare Advantage, you have special rights to buy back a Medigap policy if you’re unhappy with the MA plan: You have 12 months from enrolling in the MA plan to buy back the same Medigap policy if you switch back to Original Medicare. If that policy is no longer available, you can purchase another one.

If you enrolled in Medicare Advantage when you became eligible for Medicare (you didn’t previously have a Medigap policy), you can drop the MA plan within 12 months of joining and purchase any Medigap policy.

The Bottom Line

The best time to sign up for Medigap insurance is during the initial six-month Medigap open enrollment period that begins once you’re enrolled in Part B (and are at least 65). If you’ve missed this window, investigate whether federal or state law offers circumstances allowing you to enroll at other times. But as with most forms of insurance, the very best time to get Medigap is before you need it. 

Frequently Asked Questions (FAQs)

What is the average cost of Medicare Supplement Insurance?

It can be challenging to determine an “average” cost as states have different rules on what types of rating plans or pricing are possible. Rules also differ regarding whether your age, gender, residential area, and whether or not you smoke impact your Medigap premium. 

When can I be denied a switch of Medigap policies?

You may wish to switch from one Medigap policy to another for reasons such as wanting a less expensive policy, paying for unnecessary benefits, or needing more benefits.  However, you won’t have a right to change Medigap policies under federal law unless you’re within the 6- month Medigap open enrollment period or already eligible under a specific circumstance, or have a guaranteed issue right.

What is the difference between Medigap and Medicare Advantage?

Medigap is a plan that helps cover the “gaps” in your Original Medicare coverage, while Medicare Advantage facilitates delivery of your Part A and Part B benefits. In general, compared to Medicare Advantage, Medigap plans feature:

  • Higher premiums 
  • Fewer out-of-pocket costs
  • Ability to move with you, even if you move out of state
  • Ability to see providers of your choice
  • No prescription drug coverage