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Can You Be Denied Supplemental Insurance for Medicare?

Healthcare Writer

Last updated May 13th, 2020

Reviewed by Frank Lalli

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There’s an old television show called Beat the Clock, where contestants have to complete a task as the clock ticks down. That’s a little like the challenge you face to sign up for a Medicare Supplement plan without penalties or a Medicare Advantage plan without inconvenience. 

Signing up for supplement insurance in addition to Original Medicare can be simple. When you age into Medicare eligibility by turning 65 years old and have Part B, you cannot be denied supplemental insurance for Medicare for the next six months. That period is called the Medigap Open Enrollment Period. During that time, Medigap insurers must sell you a plan at the best available rates regardless of your health history. 

But don’t forget the deadline. If you don’t act within the enrollment period, when you finally come calling supplemental plans can charge you higher prices or deny you outright, depending on which type of supplemental coverage you want. So, whether it’s a Medicare Supplement plan or Medicare Advantage coverage, you need to act in a timely way.

Medicare Supplement (Medigap):

Your Medicare Supplement deadline is its Open Enrollment Period. Your initial OEP only lasts for six months, starting from the 1st day of the month when you’re both 65 and you join Medicare Part B. If you buy a supplement under those circumstances and during that first OEP, insurers can never deny you coverage or increase the price of your plan due to your pre-existing medical conditions, provided you maintain continuous health insurance coverage.

If you delay because you are still being covered at work, you can still be OK. Once you retire after 65, you have a “guaranteed issue right” for up to 63 days after the termination of your previous coverage. Within that time, companies must sell you a Medigap policy at the best available rate, no matter what health issues you have. You cannot be denied coverage.

Otherwise, if you don’t act within those two situations, you face new rules. You still have the right to purchase a Medigap plan at the lowest possible rate, but only if you qualify for a Special Enrollment Period. Fortunately, there are many ways to qualify for special enrollment

For instance, you qualify for special enrollment if your employer-sponsored retiree plan that supplements Medicare ends, provided you maintain continuous coverage under what’s called a “credible” health insurance plan.

Other SEP circumstances include if your employer-sponsored retiree plan continues to offer benefits but ends your supplemental coverage; or you lose eligibility as a result of the death of a primary member or divorce; or if your employer-provided retiree plan stops paying Medicare B coinsurance.

You also qualify if you relocate out of the service area of your Medicare Advantage Program for All-Inclusive Care for the Elderly (PACE), even if there is a Medicare Advantage Plan or PACE organization where you moved.

Thirty-one states also require Medigap issuers to offer plans to Medicare beneficiaries under the age of 65, although not all plans may be available or affordable. In addition, if you live In New York, Massachusetts, or Connecticut, you’re in luck. Insurers there cannot deny Medigap to state citizens or charge them extra at any time.

Medicare Advantage (Part C):

Signing up for a Medicare Advantage plan from a private insurance company involves deadlines, too. When you first become eligible for Original Medicare, you’re granted a seven-month Initial Enrollment Period to sign up for Medicare Advantage instead. Medicare Advantage plans are privately-run options that replicate Original Medicare coverage (Parts A & B) and often offer extras like prescription coverage and gym memberships. Your IEP begins three months before the month that you turn 65, and lasts for three months after the month you turn 65.

If you missed your IEP, you can still enroll in a Medicare Advantage plan during its Annual Election Period (AEP), which lasts from October 15 to December 7 every year.

In general, you can’t be denied coverage or charged more due to a health condition if you apply for Medicare Advantage during AEP — with one major exception. Medicare Advantage plans are not required to accept beneficiaries who qualify for Medicare due to a diagnosis of end-stage renal disease.

Taking the Next Steps

Learn more about Medicare coverage, and consider which options fit your budget. You can browse our collection of Medicare Supplement and Medicare Advantage plans to find what’s best for you.

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