Can You Be Turned Down for a Medicare Supplement Plan?

The short answer is yes, except during your Medicare Supplement Open Enrollment Period, which starts the first day you are enrolled in both Parts A and B of Original Medicare and ends six months later. Outside of this period, Medicare Supplement (Medigap) plans are allowed to use medical underwriting and deny you coverage or increase your premium if you have pre-existing health conditions.

Can I Be Denied Treatment for Specific Conditions?

No. Medicare Supplement (Medigap) plans are designed to supplement your Original Medicare plan and provide coverage for some of the out-of-pocket costs you may have. As long as the doctor or facility you are receiving your care from accepts Original Medicare, they will also accept your Medicare Supplement plan.

The only adjustments that the insurer can make are to deny your coverage or raise your premium.

What If I Want to Change Plans?

After the initial Open Enrollment Period, a plan that you want to change to can deny your coverage or raise your premium.

Can I Appeal a Denial of Coverage or a Premium Increase?

No. There is no mechanism for appeal of a denial of coverage or a premium increase. You can, however, apply to another insurer.

Do I Ever Have a Guarantee of Plan Issuance?

Yes. If your current plan stops, you have a right of guaranteed issuance by another plan. The acceptable reasons include:

  • You move out of your plan’s service area.
  • You have employer-provided coverage and lose it.
  • Your plan goes bankrupt.
  • Your plan changes its service area.

Ideally, if you know a loss of coverage is coming, you should change plans before it happens. If you do not, you must enroll in the new plan within 63 days.

Are There Any Exceptions?

Yes. In the states of New York, Connecticut, Maine, and Massachusetts, Medigap insurers must offer enrollment to all comers either continuously or for at least one month per year. They must accept all those who want to enroll. They can, however, raise premiums due to pre-existing conditions.

At Dale Frank Financial, we understand how important it is that you are aware of all your Medicare coverage options. That’s why we are here to help you understand your Medicare Supplement (Medigap) options as well!

*Disclosure: Do keep in mind that Dale Frank Financial offers insurance products, but is not affiliated with Medicare or the U.S. government.

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