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Original Medicare, which includes Part A and Part B, covers many of the healthcare needs of people who qualify—people 65 years and older, as well as people with specific disabilities and illnesses. But there are many things that Original Medicare does not cover. One option to fill in these gaps is to purchase a Medicare Supplement plan through a private insurer. These plans are also known as Medigap plans and can cover some of the copayments and deductibles of Medicare Parts A and B.
However, many people worry that an insurer might deny them coverage. In some cases, some people may be denied Medicare Supplement plan coverage or have to pay a higher premium. Learn if Medigap insurance can be denied and how to get and maintain the coverage you need.
What are Medicare Supplement plans?
Medicare Supplement insurance, also called Medigap, is a private insurance plan you can buy when enrolled in Medicare Parts A and B. These plans differ from Medicare Advantage plans by adding to Original Medicare. Medicare Advantage plans provide all the Medicare benefits plus any additional benefits the insurer includes in the plan.
There are ten Medigap plans with different combinations of gap coverage. These plans are lettered A, B, C, D, F, G, K, L, M, and N. Some plans have a high deductible and lower monthly premium, while others offer a higher premium and a lower deductible. Plans K and L also include an out-of-pocket limit. Medigap policies are standardized by letters and must be clearly identified as “Medicare Supplement Insurance.”
All policies offer the same basic benefits, but some offer additional benefits, so you can choose which one meets your needs.
In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.
Can you be denied Medicare Supplement Insurance?
It is possible that you can be turned down for Medicare Supplemental Insurance, but the key is when you are trying to enroll. When you turn 65, you are usually eligible to enroll in Original Medicare. Once you enroll in Part B, you begin the Open Enrollment Period (OEP) for Medigap policies. This OEP begins the first month you are enrolled in Part B if you are at least 65 and lasts for six months.
If you take advantage of this OEP, you can enroll even if you have a pre-existing condition—with one exception. People with a pre-existing condition who do not have at least six months of creditable coverage may have a delay in coverage for that pre-existing condition even if they apply during the OEP.
Creditable coverage
You might be enrolled in healthcare coverage that is as good or better than the coverage provided by Medicare. People with creditable coverage may receive coverage through a union, employer, or Medicaid. Usually, you will hear the term creditable coverage applied to Medicare Part D coverage or coverage comparable to Part D.
None of the Medigap plans that you can currently buy include Part D coverage. If you enroll in Medicare Supplement insurance, you must purchase a Part D plan separately. If you have coverage, your insurer must send you an annual notice that informs you if your coverage is still creditable. It is crucial to carefully read this notice so you can act if your plan is changing and will no longer be creditable. If this happens, you will have the opportunity to sign up for Medicare Part D during a Special Enrollment Period (SEP) or the Open Enrollment Period.
Can you be denied Medicare Supplement Insurance after the OEP?
However, if you do not enroll during the once-in-a-lifetime OEP, it is possible that you can be denied Medigap coverage. Or you might be able to enroll in a plan, but you will have to pay much higher premiums due to that pre-existing condition. If you want Medicare Supplement plan insurance, it is essential that you apply for a plan during your OEP. During this time, insurers cannot consider your pre-existing conditions or your health in general when calculating the pricing.
If you decide to enroll in Medigap after your OEP, then there’s no guarantee that insurers will provide plans. And those insurers that do could require regular health screenings.
Guaranteed Issue Rights
Other than the Open Enrollment Period, there are other particular times when insurance companies must offer you Medigap coverage without considering pre-existing conditions. These specific times are governed by guaranteed issue rights and occur when:
- You leave an employer who was providing your insurance coverage.
- You move and are no longer within your previous plan’s service area.
- Your Medigap or Medicare Advantage plan leaves Medicare or is no longer providing service in your area.
- You enrolled in Medicare Advantage when you first became eligible for Medicare, and you decide to change to Original Medicare, or you are switching back to Medigap from Medicare Advantage and were in the Medicare Advantage plan for less than a year.
Although guaranteed issue rights mean you can apply for a Medicare Supplement plan without being turned down, you do not get as much time to think about the type of Medigap plan that will work best for you. You must apply for a Medicare Supplement insurance policy no more than 63 calendar days from when your previous coverage ended.
Four states require guaranteed issue rights for all Medicare recipients 65 and older, either annually or year-round:
- Maine
- Massachusetts
- Connecticut
- New York
Pre-existing condition waiting periods
If you enroll in a Medicare Supplement plan outside of the OEP and do not have guaranteed issue rights, the insurer may place you in a pre-existing condition waiting period. During this time, you can get care unrelated to the pre-existing condition.
Original Medicare may cover some of the care related to your pre-existing condition. But you may have to pay a significant amount out-of-pocket until your waiting period is over. The waiting period can last up to six months. After that, your Medigap policy can cover care related to your pre-existing condition that Medicare Parts A and B do not cover.
Reach out to Hella Health with your Medicare Supplement enrollment questions
Hella Health offers many informative articles to help you navigate your Medicare enrollment. Searching for the best coverage for your situation can be confusing. Try Hella Health’s Medicare Coach for helpful tools to make your enrollment easier.
