4 Reasons Why Medigap May Deny You Coverage

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Medigap is supplemental insurance sold by private insurance companies that have been approved by Medicare. Medigap is there to help you cover some of the out-of-pocket costs associated with Original Medicare (Part A and Part B) if you have a chronic illness or frequent doctor visits. But did you know insurance companies can deny you Medigap coverage? Here are four reasons why you may be denied coverage.

1. You aren’t enrolled in Medicare Part A and Part B

While most people will automatically be enrolled in Medicare Part A when they turn 65, you will probably have to enroll in Medicare Part B yourself. Until you enroll in both Part A and Part B (Original Medicare), you cannot purchase a Medigap policy.

2. You have Original Medicare, but you’re younger than 65

Some people may qualify for Medicare due to a disability or certain illness, like end-stage renal disease (ESRD) or ALS. However, you could still be denied coverage because there are no federal laws requiring companies to sell you a policy. With that said, 30 states require insurance companies to sell you a Medigap policy if you’re under 65, so do your research and know what your state laws are.

3. You have a Medicare Advantage plan

It is illegal for an insurance company to sell you a Medigap policy if you already have Medicare Advantage (Medicare Part C). If you have a Medicare Advantage plan and want to switch to Original Medicare plus Medigap, you need to drop your Medicare Advantage plan first.

4. You’re not in your Medigap open enrollment period

Your 6-month Medigap open enrollment period begins when you are age 65 or older and enrolled in Part B coverage. During this enrollment period, insurance companies cannot deny you coverage based on your medical history, age, gender, or health status. However, if you have a pre-existing condition, you may have a waiting period before your coverage kicks in. More on that below.

Pre-existing conditions waiting period

If you want to purchase a Medigap policy with a pre-existing condition, you may be denied coverage or have a 6-month waiting period before your coverage kicks in. The purpose for this waiting period is to make sure people don’t wait until they have a major medical issue to buy a policy, which could raise premiums.

The waiting period is reduced by one month for each month you had creditable coverage before you purchased your Medigap policy. For example, if you don’t have insurance for four months before purchasing your policy, your waiting period will be at least four months long. If you have creditable coverage leading up to the day you purchase a Medigap policy, you likely won’t have a waiting period. 

Medical underwriting

Medical underwriting is where private insurance companies that sell Medigap can limit or deny coverage or charge you more for your premiums based on your health history. This might happen if you switch from Medicare Advantage to Original Medicare plus Medigap and have a pre-existing condition on your health record.

To avoid medical underwriting, it’s important to apply for a Medigap policy when you first get the opportunity to do so: in the 6-month window after you get Part B coverage.

 

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