Can you be refused Medigap insurance?
Yes, Medigap (Medicare Supplement) insurance companies can deny you coverage based on your health history or pre-existing conditions, but only if you apply outside of specific protected enrollment windows.
When Medigap Cannot Deny You
- Medigap Open Enrollment Period: This is a one-time, 6-month window that starts the month you turn 65 and enroll in Medicare Part B. During this time, insurance companies cannot deny you a plan or charge you higher premiums due to health conditions.
- Guaranteed Issue Rights: If you experience certain life events—such as losing employer-sponsored coverage, moving out of a Medicare Advantage service area, or using a 12-month trial right to leave a Medicare Advantage plan—federal rules give you a guaranteed right to buy a Medigap policy without health underwriting.
- State Protections: Certain states (like New York, Connecticut, Massachusetts, and Maine) have unique state laws providing continuous or periodic guaranteed issue protections regardless of when you apply.
When Medigap Can Deny You
- Applying After Open Enrollment: If you miss your initial 6-month open enrollment window and do not qualify for a guaranteed issue right, insurers can subject you to medical underwriting.
- Medical Underwriting Risks: During underwriting, the insurance company reviews your medical history, current health, and prescription drug use. They can legally refuse to sell you a policy if you have certain pre-existing conditions (such as active cancer treatments, heart conditions, or specific uninsurable medications).