Medicare Supplement Plans, or Medigap, are extremely popular with seniors. About 12 million people, or 1 in 4 seniors, have a Medigap plan. Did you know, however, that you can be turned down for Medigap coverage?
Unlike Original Medicare, which is administered by the federal government and available to anyone with a qualifying work history, Medigap plans are provided by private insurance companies. That means they can determine whom they will cover and how much they charge for that coverage, unless you have guaranteed issue rights (more about that later).
If you are approaching Medicare eligibility, and think you want Medigap coverage, here’s what you need to know before it’s too late.
When is the Medigap Open Enrollment period?
If you want Medigap coverage, it’s best to buy it during your open enrollment period. This period begins the first month in which you are both age 65 or over and enrolled in Part B. It lasts for six months. You only get one open enrollment period at 65 and once it’s gone, it’s gone.
During this time, you have the right to purchase any plan available in your state. The insurance company cannot charge you more for your plan regardless of your health status. They also cannot apply any waiting periods for pre-existing conditions either.
If you wait to enroll, the insurance company may use medical underwriting to decide whether to issue you a policy. The medical underwriting process looks at your past health history. Underwriters review current medical status, age, and other health factors to determine whether you would be a good risk for coverage.
If you have a serious or chronic health condition, you may be denied coverage. In some cases you might be issued but charged significantly higher premiums, making the policy unaffordable.
You only have protection during your open enrollment period and during other certain situations in which you have guaranteed issue rights. So, if you plan to get Medigap coverage, don’t let these periods go to waste.
What are Medigap Guaranteed Issue Rights?
Guaranteed issue rights protect your ability to buy a Medigap plan without going through the medical underwriting process. Keep in mind, however, that guaranteed issue rights are time sensitive. This means that they only last for a short period of time from the date of the qualifying event, usually around 63 days.
Here are a few situations where you have Medigap guaranteed issue protections:
- If you have Original Medicare and an employer or union group plan, and your coverage is ending under the private plan, you can buy one of the Medigap plans listed above.
- If your Medigap company goes bankrupt or you lose your coverage through no fault of your own, you can also buy a new Medigap plan.
- You joined a Medicare Advantage plan when you first became eligible for Medicare. Within the first year of coverage, you have decided you want to switch to Original Medicare. You may buy certain Medigap plans (only plans A, B, C, F, K, or L) at that time.
- You enrolled in a Medicare Advantage plan that is leaving the Medicare program, or you have moved out of the plan’s service area. Then you can enroll in Original Medicare and buy a Medigap plan, but only Plans A, B, C, F, K, or L.
There are other instances where you may have Medigap protections. If you’re not sure whether they apply to you, talk to an experienced Medicare insurance specialist.
Remember, however, that your plan options may be limited even with guaranteed issue rights. For example, if you want one of the more comprehensive, first-dollar plans like Plan C or Plan F, you need to enroll during your open enrollment period.
Can I be denied Medigap coverage because of a pre-existing condition?
You can’t be denied coverage if you enroll during the open enrollment period or during a time when you have guaranteed issue rights.
If you apply for coverage outside those periods, however, you are subject to Medigap underwriting. Insurance companies can also apply a “look-back period.” Your insurance company can look at your health records for the past six months. If they find something, they can apply a waiting period for any conditions that your doctor diagnosed during that time. During the waiting period, your Medigap plan will not pay any covered expenses related to treatment for the pre-existing condition.
For example, let’s say you were diagnosed with diabetes in February. You apply for Medigap coverage to begin on May 1st. Your Medigap plan could choose not to pay any claims related to your diabetes until December 1st. It will pick up costs for other covered healthcare services, just not those associated with treatment of diabetes.
There are no specific guidelines about which conditions will exclude you from coverage or cause a waiting period. Each individual Medigap provider sets its own medical underwriting rules. If one company turns you down for Medigap coverage, you may be able to get coverage from a different company. Sometimes state rules also apply
Can You Qualify for Medigap Coverage?
Need help determining if you qualify for Medigap coverage? Reach out to the friendly Medicare experts here. We can walk you through the health questions and help you determine your options.