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Can You Be Denied a Medicare Supplement Plan?



Once of the most worrisome parts about applying for a Medicare Supplement is the fear of getting denied. So let's talk.... can you be denied a Medicare Supplement/Medi-Gap plan? The simple answer is both yes and no...


There are certain periods throughout the year when you are allowed into a Medicare Supplement plan regardless of your existing health conditions; the company you're applying for HAS TO accept you. There periods are called Open Enrollment or Guarantee Issue periods. Let's discuss the most common ones:

Open Enrollment: When you first age into Medicare at 65, you are given an Open Enrollment period that lasts 7 months. You may sign an application 3 months prior to turning age 65, the month you turn 65 and 3 months after you turn 65. During this 7-month window, an insurance company must accept you.


The second most common Open Enrollment period is what we call the Birthday Rule; this is available in California, Oregon and Nevada and a couple other states (contact us to see if yours is one not listed). Using the Birthday Rule, an individual who has a Medicare Supplement plan already in effect may move to another company with a lesser premium - as long as that individual is moving to the same plan or one with lesser benefits. For example: you may move from a Plan G with Company A to a Plan G or a Plan N with Company B around your birthday. In CA, the Birthday Rule period lasts 90 days: 30 days before your birthday (for most companies) and 60 days after (for all companies). If you apply during this period, you cannot be denied.


These are not the only Open Enrollment opportunities available. Contact us to see if you qualify for one not discussed.


Guarantee Issue: One of the most common Guarantee Issue periods is when you retire and/or subsequently get dropped from your group plan. Within 6 months of the date you lose your coverage, you may apply for a Medicare Supplement plan and your acceptance is guaranteed. This includes losing coverage due to divorce or death of a spouse.


The second most common Guarantee Issue period is when you move out of your existing coverage's service area. If you Medicare Advantage plan or Medicare Supplement plan does not service the area you are moving to, you may enroll in a Medicare Supplement plan within 6 months of your prior coverage being terminated.


These are not the only Guarantee Issue periods available. There are countless more. Contact us to see if you quality for one not discuss.


Now for the bad news.... if you do not qualify for any Open Enrollment or Guarantee Issue periods, there is a chance you can be denied. You will apply and the company will then put you through underwriting. This will consist of answering health questions on an application, a phone interview and possibly medical history being viewed. At the company's discretion, you will either be accepted or denied. Should you be denied, the company will send you a letter informing you of why you were denied. An agent will not have access to denial reason as this is PHI (protected health information).


But here's the good news.... almost every single company will allow you to apply at no additional cost to you. So it never hurts. Don't be shy. You might be accepted and will have worried for no reason!


We recommend applying for coverage as soon as you're eligible and you will not have to worry about being denied. Give us a call when you turn age 65 and/or leave your group plan. We'll take care of the rest!


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