Do Medicare Supplement plans have to accept you?
Asked by: Dr. Cathy Pacocha DDS | Last update: October 5, 2025Score: 4.9/5 (68 votes)
Can a provider refuse to accept a Medicare Supplement plan?
Medigap plans themselves do NOT have networks. If your doctor is a non-participating provider with Medicare itself (rare), then they will NOT accept your Medigap plan either. If Medicare is not accepted, there is nothing for the Medicare Supplement/Medigap plan to “supplement”.
Can you be denied a Medicare Supplement plan?
At other times, insurance companies may refuse to sell you a policy. If you have or had health problems, you may not be able to buy the Medigap plan of your choice unless you are in open enrollment or a guarantee-issue period.
Do Medicare Supplement plans require prior authorization?
Broadly speaking, Medicare Supplement plans provide better access to care. By significantly reducing out-of-pocket expenses, they ensure the cost of services isn't a barrier to care. They also don't limit your access through provider networks and prior authorization requirements.
Can Medicare Supplement plans deny for pre-existing conditions?
Do Medicare Supplement insurance plans cover preexisting conditions? Yes. However, a Medigap insurance company can refuse to cover pre‑existing conditions for up to 6 months after enrollment. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover those conditions.
Do I need a Medicare Supplement Plan?
Can you be turned down for a Medigap plan?
However, in all but four states, beneficiaries may be denied a Medigap policy if they have a pre-existing condition if they choose to switch from Medicare Advantage to traditional Medicare outside the initial trial period or seek to purchase a Medigap policy years after enrolling in Medicare.
Can preexisting conditions be denied?
Coverage for pre-existing conditions
No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Once you're enrolled, the plan can't deny you coverage or raise your rates based only on your health.
Can I get a Medicare Supplement plan without medical underwriting?
You can transfer to an open plan of equal or lesser value during your Open Enrollment Period, starting on the first day of your birthday month and ending 60 days after your birthday, without going through underwriting. (That means no medical exam is required.)
What happens if you don't get prior authorization?
If you don't obtain it, the treatment or medication might not be covered, or you may need to pay more out of pocket. Review your plan documents or call the number on your health plan ID card for more information about the treatments, services, and supplies that require prior authorization under your specific plan.
Do you need a referral with a Medicare Supplement plan?
General features of Medicare Supplement insurance plans
No network restrictions mean you can see any doctor who accepts Medicare patients. You don't need a referral to see a specialist. Coverage goes with you anywhere you travel in the U.S. There is a range of plans available to fit your health needs and budget goals.
What is the downside to Medicare Supplement plans?
There are a couple of cons to consider before choosing a Medigap plan: Premiums: Medigap premiums can be pricey. Coverage: Medicare Supplement plans don't cover everything, so you'd still have to pay out of pocket for things like dental care, vision care and long-term care.
Do Medigap plans have to accept you?
You can buy any Medigap policy sold in your state. An insurance company can't use medical underwriting to decide whether to accept your application - they can't deny you coverage due to pre-existing health problems.
Can you get supplemental health insurance with a pre-existing condition?
Yes. Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.
Do most doctors accept Medicare Supplement plans?
No, not all doctors will accept your Medicare supplement Plan G. However, if your doctor accepts Medicare assignment, meaning they work with Original Medicare (Parts A and B), they will also accept your Medigap insurance.
What are the top 5 Medicare Supplement plans?
💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.
Can you be dropped from a Medicare Supplement plan?
Under certain circumstances, insurers can cancel Medicare Supplement Insurance Plans. One reason, for example, is the case of non-payment on policy holder premiums. If a policyholder fails to pay the premiums on time, the insurer has the right to cancel the coverage.
How do I avoid prior authorization denial?
Be especially thorough with your documentation when ordering treatments or services you know do not follow the standard guidelines. Create prepopulated forms, ideally using the insurer's own forms, listing codes, diagnoses, and other information the insurer typically requires to process a prior authorization.
Which health insurance company denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
Whose responsibility is it to get prior authorization?
The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider. As mentioned in the “How does prior authorization work?” section above, this will then often prompt a time-consuming back and forth between the provider and payer.
Can you be denied Medigap?
After that open enrollment period, if you want to buy a Medigap plan, you can be denied coverage based on a pre-existing condition or face a pre-existing condition exclusion period.
What is the waiting period for Medicare Supplement?
You can buy a Medigap policy once you sign up for Medicare.
This is the 6-month period that starts the first day of the month you're 65 or older and signed up for Part B. After this period, your options to buy a Medigap policy may be limited and the policy may cost more.
What happens if you can't afford a Medicare Supplement plan?
If you are still finding yourself squeezed, look into a Medicare Savings Progam. There are four different programs with different asset and income criteria. These programs can help you to pay for Part A and Part B. They can also enroll you in the Extra Help program to assist with Part D costs.
What is the Medicare rule for preexisting conditions?
Regardless of whether or not someone has preexisting conditions, if they are over 65, they can enroll in a Medicare plan. Preexisting conditions do not affect premiums either, so the cost will be the same.
How far back is a pre-existing condition?
A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.
Can UnitedHealthcare deny coverage for preexisting conditions?
Summary. Pre-existing condition exclusions are no longer applied to members covered under health insurance policies and group health plans. These rules apply equally to collectively bargained and non-collectively bargained plans.