Being denied Medigap coverage is rare, but still possible – especially if you have a pre-existing medical condition. We’ve talked about Medicare and Medicare Advantage covering pre-existing conditions, but what about Medigap? Continue reading to learn how you can prevent being denied Medigap coverage.

Key Takeaways

  • Medical Underwriting is when health insurance companies review your health history to decide how much to charge you for policies (or reject you based on pre-existing conditions).
  • To avoid Medical Underwriting, make sure to enroll in Medicare and Medigap within the Open Enrollment Period.
  • Open and Special Enrollment information can be found on Medicare.gov.
  • Seniors who suddenly lose their health insurance can avoid medical underwriting under the Guaranteed Issue Rights policy.

Medigap and Pre-Existing Conditions

While Medicare covers healthcare costs associated with pre-existing conditions, Medigap may not. Companies that offer Medigap do not have to follow the same guidelines when regarding those with pre-existing conditions. They may still offer coverage, but will impose longer waiting periods or charge high prices. Enrolling in the right period in the correct way can help get rid of these restrictions on your healthcare policy.

How to Avoid Medical Underwriting

Medical underwriting is the use of medical history or examination to determine what kind of coverage you may receive and at what price. This can be a hassle for those with pre-existing conditions who frequently need medical care. To avoid medical underwriting and enroll in a Medigap policy, it is crucial to enroll during the Open Enrollment Period. To understand when your Open Enrollment Period is you must visit the Medicare.gov website. The Open Enrollment Period for healthcare coverage in 2021] is November – December of 2020. Those who enroll in a Medigap policy within their designated period will avoid being subject to medical underwriting altogether. Doing so can prevent long waiting periods, subject to medical underwriting altogether. Doing so can prevent long waiting periods, getting charged higher rates for coverage, limited coverage policies, getting charged higher rates, or being rejected based on pre-existing conditions.

If you live in the states of Connecticut, Maine, Massachusetts, or New York, you are in luck. These four states mandate that providers must sell their policies to seniors who missed their Open Enrollment Period without going through the medical underwriting process. Providers in these states must continuously provide healthcare enrollment throughout the entire year or for at least one month outside of the open enrollment period. This allows seniors 65 or older to access Medigap benefits despite any pre-existing conditions they may have.

Guaranteed Issue Rights

You can also avoid medical underwriting under the Guaranteed Issue Rights policy. This regulation allows seniors who suddenly lost their health insurance to enroll outside of their Open Enrollment period. Reasons for sudden health insurance loss include: moving outside of your network, your local Medicare Advantage or Medigap provider going bankrupt, or leaving a job that offered healthcare coverage. Enrolling under these special circumstances will allow you to obtain Medigap coverage while never undergoing the medical underwriting process.

Enrolling for Medigap coverage before the age of 65 can result in a longer waiting period, surged coverage cost, or getting denied coverage. Typically, enrolling for Medigap prior to the age of 65 is due to having ESRD (End-Stage Renal Disease) or another qualifying health condition. Providers will typically base your costs, coverage, or lack of coverage on your pre-existing health condition.

What to Do If Medical Underwriting Is Involved

Some private insurance companies won’t cover seniors and will outright deny them with or without medical underwriting. If you run into one of these scenarios, try enrolling again with a different company. All Medigap insurance companies have different policies and standards and shopping through different options is the best way to ensure you get the best coverage at the best price possible.

Some candidates who must submit to medical underwriting despite visiting multiple insurance companies may still be accepted and receive coverage. Although receiving coverage is a good sign, the coverage may result in a higher monthly premium. They may also be subjected to a waiting period of six months before their Medigap policy will pay for coverage associated with their pre-existing condition. Both situations may also apply.

Again, if you have a pre-existing condition, make sure to enroll during the Open Enrollment Period. If you need help deciding when the Open Enrollment Period is or want to get a head start on comparing plans, visit Medicare.gov or compare quotes online with us at Medigap.com.

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