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An application for medicare supplement coverage may not be denied by the insurer if the application

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Be aware that under federal law, Medigap policy insurers can refuse to cover your prior medical conditions for the first six months. A prior or pre-existing condition is a condition or illness you were diagnosed with or were treated for before new health care coverage began.

The wait time for your Medigap coverage to start is called a pre-existing condition waiting period. You can avoid such waiting periods if you buy your policy when you have a guaranteed issue right. If you buy your policy when you have a guaranteed issue right, the insurer cannot impose a waiting period for coverage of any prior medical condition.

You can also avoid or shorten a pre-existing condition waiting period if you buy a policy during your open enrollment period. During this protected period, Medigap policies must shorten any pre-existing condition waiting period by the number of months you had prior creditable coverage. Most forms of health coverage count as creditable.

Here’s how this works: your pre-existing condition waiting period is reduced by one month for each month you were enrolled in creditable coverage prior to purchasing a Medigap. If you had creditable coverage for two months before you purchased a Medigap, your policy could only impose a four month waiting period, instead of six months. If you had six or more months of prior creditable coverage, Medigap insurers must cover your prior medical conditions immediately. Keep in mind that you cannot use creditable coverage to reduce your pre-existing waiting period if you had a break in coverage of more than 63 days.

Make sure to consider several Medigap policies, especially if you are concerned about facing a waiting period. Some policies do not impose pre-existing condition waiting periods.

Note
New to Medicare? Learn how to get started.

Follow 4 steps to buy a policy.

Tips for filling out your application 

  • Fill out the application carefully and completely, including medical questions. The answers you give will determine your eligibility for open enrollment or guaranteed issue rights (also called "Medigap protections").
  • If your insurance agent fills out the application, check to make sure it's correct.
  • Remember that the insurance company can't ask you any questions about your family history or require you to take a genetic test.
  • If you buy a Medigap policy during your Medigap Open Enrollment Period , the insurance company can’t use any medical answers you give to deny you a Medigap policy or change the price.
  • If you provide evidence that you're entitled to a guaranteed issue right, the insurance company can't use any medical answers you give to deny you a Medigap policy or change the price.

How to pay for your policy

It's best to pay by check, money order, or bank draft. Make it payable to the insurance company, not the agent. If you buy from an agent, get a receipt with the insurance company's name, address, and phone number for your records. Some companies may offer electronic funds transfer (automatic payment from checking account or credit card).

Decide when your policy should start

Ask for your policy to become effective when you want coverage to start. Generally, Medigap policies begin the first of the month after you apply. If, for any reason, the insurance company won't give you the effective date for the month you want, call your State Insurance Department.

You paid for your policy, but it hasn't started 

If it's been 30 days and you didn't get your Medigap policy (like your Medigap card or proof of insurance), call your insurance company.

If it's been 60 days and you didn't get your Medigap policy, call your State Insurance Department.  

  • Find a Medigap policy.
  • Call your State Health Insurance Assistance Program (SHIP).
  • Call your State Insurance Department.

Guaranteed Issue Rights (Also Called "Medigap Protections")

 are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:

  • Must sell you a Medigap policy
  • Must cover all your pre-existing health conditions
  • Can't charge you more for a Medigap policy because of past or present health problems

In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health coverage. In other cases, you have a "trial right" to try a 

Medicare Advantage Plan (Part C)

 and still buy a Medigap policy if you change your mind.

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.

You have the right to buy 

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state.

Note

Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.

You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.

You can/must apply for a Medigap policy:

  • As early as 60 days before the date your coverage will end
  • No later than 63 calendar days after your coverage ends

Medigap coverage can't start until your Medicare Advantage Plan coverage ends.

You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.

You have the right to buy 

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state.

Note

Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.

If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.

You can/must apply for a Medigap policy no later than 63 calendar days after the latest of these 3 dates:

  • Date the coverage ends
  • Date on the notice you get telling you that coverage is ending (if you get one)
  • Date on a claim denial, if this is the only way you know that your coverage ended

Note:

Your rights may last for an extra 12 months under certain circumstances.

You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy's service area.

You have the right to buy

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state.

Note

Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.

You can/must apply for a Medigap policy:

  • As early as 60 calendar days before the date your coverage will end
  • No later than 63 calendar days after your coverage ends

Call the Medicare SELECT insurer for more information about your options. Find the phone number for the Medicare SELECT company.

You joined a Medicare Advantage Plan or Program of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)

You have the right to buy any Medigap policy that’s sold by any insurance company in your state.

You can/must apply for a Medigap policy:

  • As early as 60 calendar days before the date your coverage will end
  • No later than 63 calendar days after your coverage ends

Note:

Your rights may last for an extra 12 months under certain circumstances.

You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)

You have the right to buy:

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it.

If your former Medigap policy isn't available, you can buy a Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state.

Note

Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.

You can/must apply for a Medigap policy:

  • As early as 60 calendar days before the date your coverage will end
  • No later than 63 calendar days after your coverage ends

Note:

Your rights may last for an extra 12 months under certain circumstances.

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You have the right to buy:

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state.

Note

Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.

You can/must apply for a Medigap policy:

No later than 63 calendar days from the date your coverage ends.

You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you.

You have the right to buy:

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state.

Note

Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.

You can/must apply for a Medigap policy:

No later than 63 calendar days from the date your coverage ends.

Note

There may be times when more than one of the situations above applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice.

Can I buy a Medigap policy if I lose my health coverage?

You may have a guaranteed issue right to buy a Medigap policy. Make sure you keep these items:

  • A copy of any letters, notices, emails, and/or claim denials that have your name on them as proof of your coverage being terminated

  • The postmarked envelope these papers come in as proof of when it was mailed

You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right.

If you have a Medicare Advantage Plan but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the plan. Ask that the new policy take effect no later than when your Medicare Advantage enrollment ends, so you’ll have continuous coverage.

Note

The guaranteed issue rights in this section are from federal law. These rights are for both Medigap and Medicare SELECT policies. Many states provide additional Medigap rights.

If you have questions or want to learn more about Medigap rights in your state:

  • Call your State Health Insurance Assistance Program to make sure that you qualify for any of these guaranteed issue rights.

  • Call your State Insurance Department if you’re denied Medigap coverage in any of these situations.

Can I be denied a Medicare Supplement plan?

The first important thing to know is that if you buy Medicare Supplement insurance during your Open Enrollment period, you cannot be denied, even if pre-existing medical conditions exist.

When can someone enroll in a Medicare Supplement without the chance for denial premium increase or exclusions due to pre

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.

Is it possible to get a Medicare Supplement plan with no underwriting?

Sometimes you can join a Medigap plan after the Medigap Open Enrollment Period without undergoing a medical underwriting review. For example, if you're enrolled in a Medicare Advantage plan and the plan leaves the Medicare program, you might have a “guaranteed-issue right” to a Medigap plan.

Can Medigap deny claims?

So, Medigap plans can deny coverage or impose pre-existing condition exclusion periods, even if individuals are eligible for Medicare.

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