Medigap plans are sold by private insurance companies to work with your original Medicare insurance (Part A and B) and to cover the cost of ownership, such as: coinsurance, co-payments, and deductibles. These plans can help you reduce your Medicare costs, especially if you are receiving extensive medical care.
In 47 states (excluding Massachusetts, Minnesota and Wisconsin who have their own standard plans), Medicare plan names with letters are standardized. If you are registered with Medicare, you may be refused a Medigap plan only under certain situations or condition. The conditions listed below are not exhaustive, but it can help you understand the limited circumstances in which you can be refused a Medicare supplement plan.
Rejected for Medicare Supplement plan
1: You are not enrolled for Medicare Part A and B.
To enroll in a Medicare supplement plan, you must have Medicare Part A and B. If you do not have Part A or Part B, or just Part A or only Part B, you do not qualify for Medicare Supplement Insurance. Medicare supplemental plans are only for Medicare beneficiaries with Part A and B.
Rejected by the Medicare Supplement Condition
2: You are signed up for a Medicare Savings Account (MSA) or a Medicare Advantage Plan.
It is illegal for anyone to sell you a Medicare supplement policy if you have a Medicare Savings Account (MSA) Plan or another Medicare Advantage plan, unless you return to Original Medicare. Medicare supplemental plans do not go hand in hand with Medicare Advantage plans. Should you have Medicare Advantage plan, you may still request a Medicare supplement. However, you must cancel the Medicare Advantage plan before the Medicare supplement plan begins.
Rejected by Medicare Supplement
3: You are under 65 but have Medicare Part A and B,
Some people are eligible for Medicare coverage for people under 65 because they have a disability or condition, such as Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD). However, federal law does not require private insurance companies to sell Medicare supplemental policies to people below the age of 65. Some states request that private insurers in the state sell Medicare Supplement policies to individuals below the age of 65. You may be denied Medigap insurance if you suffer from ESRD and you reside in state like California or Vermont, which under certain circumstances sell Medicare supplement to individuals below the age of 65.
Rejected for Condition 4 of the Medicare supplement:
You are not in the open enrollment period of your Medicare supplement.
You can decline a Medicare supplement policy by requesting the Medicare supplement application outside of the open enrollment period. This open enrollment period lasts for 6 months and begins the month in which you are at least 65 years of age and enrolled in Medicare Part B.
Within this period, an insurance company may ignore your health status when evaluating your claim. However, a qualification period may apply to your health status. Regardless of health problems, you can sign up for any Medigap plan that is available in your state.