Medicare Supplement plans require medical underwriting in most cases. Insurers have different guidelines their underwriting departments use. Just because you cannot get coverage with one carrier does not mean another won’t accept you.

Being medically underwritten means, you must answer medical questions and allow the company to look into your health history.

As we get older, we don’t get healthier. That’s why it is wise to enroll in a Medigap plan earlier than later. We’re more likely to have a declinable medical condition as we age. That doesn’t mean we can’t get coverage. It means we don’t have as many options.

What Medical Conditions Cause a Medigap Denial in Coverage

Denial of coverage is usually due to severe or chronic illnesses. We’ll separate them into categories.

Chronic Respiratory Disease

Chronic respiratory diseases are a disease of the airways or other structures of the lung. Common chronic respiratory diseases include Chronic Obstructive Pulmonary Disorder (COPD), Chronic Bronchitis, Asthma, and pulmonary Hypertension.

You may be medically disqualified for Medigap coverage if you have a chronic respiratory disease. There are exceptions. If you have Asthma and have less than three inhalers to keep it under control, some carriers will accept you.

Chronic Cardiac Disease

Chronic cardiac diseases are related to your heart and circulatory systems. Examples of chronic cardiac diseases are Atrial Fibrillation (AFIB), Congestive Heart Failure (CHF), Hypertension (High Blood Pressure), and Congenital Heart Disease.

You may not pass underwriting with chronic heart conditions. There are always exceptions. If you only have high blood pressure, many carriers will accept you if you have no other major health conditions.

Chronic Cognitive and Neurological Disorders

Chronic cognitive disorders are mental health disorders that affect memory, learning, perception, and problem-solving. These include Alzheimer’s Disease, Dementia, Transient Ischemic Attacks (TIA), and Strokes.

Cognitive disorders are usually a medical decline. Most companies won’t approve coverage for someone suffering from cognitive disorders.

Nervous System and Neuromuscular Diseases

Nervous system diseases are conditions that affect the brain and nerves. Amyotrophic Lateral Sclerosis (ALS), known as Lou Gehrig’s Disease, Multiple Sclerosis, Epilepsy, Fibromyalgia, and Myasthenia Gravis, are examples.

Some nervous system and neuromuscular disorders are more severe than others. ALS will always decline, but epilepsy may not. It depends on the medical history and medications taken. Using oxygen or using a nebulizer will decline in most cases.

Chronic Renal Disease

Chronic renal diseases result in gradual loss of kidney functions like End-Stage Renal Disease (ESRD), and Polycystic Kidney Disease (PKD)

In most cases, chronic renal disease will result in denial. Often the final step in treatment includes kidney transplants.

Auto-Immune Disorders

Auto-immune disorders attack our immune system making it harder to fight off illnesses. Acquired Immunodifencicy Syndrome (AIDS), Human Immunodeficiency Virus (HIV), Rheumatoid Arthritis, Psoriatic Arthritis, and Systemic Lupis

Diabetes

Diabetes isn’t a decline if you meet the criteria. For example, if you take less than 50 units of insulin a day and have no complications other than diabetes, many plans will accept you.

Cancer

Cancer is an evil disease that has been around for far too long. Cancer will cause a decline. Fortunately, more people are living through and beating it. Once clear for more than two years, carriers will start to consider approving you for coverage.

One of two men and one of three women will have cancer. A critical illness plan is a great and inexpensive way to have extra coverage that you can use for leftover medical bills, prescription costs, and even travel. You get paid a lump sum tax-free chunk of money to use however you see fit.

Of course, this isn’t a complete list, and many we have listed above could be accepted. It depends on the severity of the condition. You will have to speak with a licensed agent, and ultimately the company you apply for will make the determination.

How Can I Get Coverage if my Medicare Supplement is Denied?

If your application gets denied, there are a few options available.

  • Medicare Advantage – A Medicare Advantage plan is an option if your Medicare Supplement application isn’t accepted. These plans combine your Part A, Part B, and in many cases your, Drug coverage into one. They provide plan extras that Medicare does not offer, such as Dental, Vision, and Hearing.
  • Appeal the decision – If your Medicare Supplement application isn’t approved, you can appeal the denial. Usually, this will require you to get a letter and a form filled out by your health care provider. There is no guarantee that your appeal will be approved. I have seen many appeals won by clients over the years.
  • Guaranteed Issue – Some situations allow you to be issued a plan no matter your health.

If you have chronic conditions, don’t feel like you’re alone. Many Americans have them as well. You can get healthcare if you have a medical condition that falls into the categories above.

Every insurance carrier has underwriters that look into each case. If your condition is mild or well-controlled, you may be able to pass underwriting.

How to Get Help with a Medigap Denial

Wonder if a Medicare Supplement is the right direction for your needs? Give us a call. You can fill out our online request form if now is not a good time. We have licensed agents available to assist you with any of your Medicare questions and needs.

Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.