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Can I Be Denied a Medicare Supplement Plan?

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Whether you can be denied supplemental insurance for Medicare depends on when you apply for the coverage. Timing is crucial if you want to enroll in a Medicare Supplement plan without penalties.

The process is simple if you beat the clock. When you turn 65, age into Medicare, and sign up for Part B coverage, you cannot be denied Medicare supplemental insurance for the following six months. That six-month time period is known as the Medigap Open Enrolment Period. During that time, insurance companies that sell Medigap policies are required to sell you a plan at their best available rates. This requirement applies regardless of your health history.

However, if you fail to act during the Medigap Open Enrollment Period, insurers selling supplemental plans can charge you higher premiums or deny you coverage altogether. For this reason, it is important to act timely if you want Medigap coverage to supplement Original Medicare.

When Does the Medigap Open Enrollment Period Start?

Your initial Open Enrollment Period begins on the first day of the month when you are 65 and you enroll in Medicare Part B. It continues for six months thereafter. If you purchase a Medicare supplement plan during the initial Open Enrollment Period, insurers cannot deny you coverage or increase the cost of your plan because of preexisting medical conditions, provided you maintain continuous health coverage.

What If You Don’t Enroll in Medicare at Age 65?

If you delay enrolling in Medicare after you turn 65 because you have health coverage at work, you should still have the opportunity to purchase guaranteed Medigap coverage at the best available rates. When you retire after age 65, you have a guaranteed issue right to purchase Medicare supplemental insurance for up to 63 days after your previous health coverage terminates. During that time, the same rules apply as during the initial Open Enrollment Period. Health insurance companies cannot deny you coverage and must sell you a Medigap policy at the best available rates.

What Happens If You Miss the Deadline for Medigap?

If you fail to purchase a Medigap policy within the allotted time period, you still have the right to purchase this coverage at the lowest possible rate, provided you qualify for a Special Enrollment Period. There are various ways to qualify, for example:

  • If you had an employer-sponsored retiree plan that supplemented Medicare and the plan ended, you can qualify for a Special Enrollment Period, provided you maintained continuous coverage under a credible health insurance plan.
  • You can qualify for a Special Enrollment Period if you relocate out of the service area of your Medicare Advantage Program for All-Inclusive Care for the Elderly (PACE).
  • If you lose eligibility in an employer-sponsored retiree plan because of divorce or the death of a primary member; if the plan continues offering benefits but ends your supplemental coverage; or if the plan stops paying Medicare Part B coinsurance, you can qualify for Special Enrollment.

If you need a Medigap plan to supplement Original Medicare, meet with one of our experienced agents. We can help you purchase the supplemental coverage you need.

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