When an application for Medicare Supplement coverage may not be denied by the insurer?
Asked by: Marcelina Prohaska | Last update: December 14, 2025Score: 4.8/5 (3 votes)
Can Medicare supplemental insurance be denied 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.
Which of the following statements is true about a Medicare Supplement policy?
Final answer: The statement that is true about Medicare Supplement policies is that they are designed to cover the deductibles and coinsurance that Medicare patients have to pay, making option D, IV only, the correct answer.
Can you be denied a Medicare Supplement plan during open enrollment?
Buying During the Open Enrollment Period
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.
Can Medigap insurers deny coverage?
Under current federal law, insurance companies that sell Medigap policies may refuse to sell a policy to an applicant with certain medical conditions, or who has had certain medical procedures or used specific prescription drugs, outside of open enrollment or a guaranteed issue period.
Medicare Supplement coverage denied? Why insurance companies deny you (and what to do about it).
Can a doctor refuse a Medicare Supplement?
The short answer is “No”. However, if a doctor accepts Medicare itself, which is your primary coverage, then they will also accept your Medigap plan, regardless of what company sold you the plan or which Medigap plan you have. The key thing to remember is that Medigap plans “follow” Medicare.
What is a common reason for Medicare coverage to be denied?
Many denials are due to reasons such as not meeting medical necessity; frequency limitations; and even basic coding mistakes. Denials are subject to Appeal, since a denial is a payment determination.
What is the 6 month rule for Medigap insurance?
You have the right to purchase a Medigap policy for 6 months if you move out of the area served by your Medigap plan. For example, if you bought a plan while living in another state that will not cover you in your current state, you have 6 months to replace that plan.
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 are the disadvantages of a Medicare Supplement plan?
What are the disadvantages of a Medigap plan? 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.
What is required in a Medicare Supplement policy?
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable.
Which of the following would prohibit a person from purchasing a Medicare Supplement policy?
Based on this evaluation, the most appropriate answer to which option would prohibit a person from purchasing a Medicare Supplement policy is A. A pre-existing condition, but it should be noted that this is more nuanced than a simple prohibition.
Which states allow you to change Medicare Supplement plans without underwriting?
Medigap state variation
Five states (California, Idaho, Illinois, Nevada, and Oregon) have “birthday rules” that allow Medigap enrollees a 30-day window following their birthday each year when they can switch, without medical underwriting, to another Medigap plan with the same or lesser benefits.
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 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.
Which of the following is true about Medicare Supplement insurance plans?
Which of the following is true about Medicare Supplement Insurance Plans? They are regulated by the Centers for Medicare & Medicaid Services (CMS).
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.
Can you get supplemental 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.
Which states have guaranteed issues for Medigap?
State laws can provide further protections, but only four states— Connecticut, Massachusetts, Maine, and New York—require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in traditional Medicare ages 65 and older, regardless of their medical history.
Can you be turned down for Medigap?
Outside of your Medigap Open Enrollment Period: You may have to pay more for a policy. Fewer policy options may be available to you. The insurance company is allowed to deny you a policy if you don't meet their medical underwriting requirements.
Can Medicare deny coverage for preexisting conditions?
While Original Medicare doesn't restrict coverage based on pre-existing conditions, the rules are different for Medicare Supplement insurance plans. In some cases, insurance companies can review your medical history and charge you more, impose a waiting period for coverage, or deny your application altogether.
Is there a waiting period for Medicare Supplement plans?
A: If you already have Medigap insurance, you have 60 days of "open enrollment" following your birthday each year when you can buy a new Medigap policy without a medical screening or a new waiting period.
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.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
What do I do if my Medicare application is denied?
you can file an appeal. Before you start an appeal, you can ask your provider or supplier for any information to make your appeal stronger. If you're in a Medicare Advantage plan, other health plan, or a drug plan, check your plan materials, or contact your plan, for details about your appeal rights.