3 Ways to Avoid Being Rejected or Overcharged for a Medigap Policy

Knowing when to sign up can help you get the coverage you need

Kimberly Lankford,

AARP

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En español

Published December 06, 2021

/ Updated September 07, 2023

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Even after you sign up for Medicare, you still have to pay deductibles and copayments for hospital stays, doctor visits and other health care expenses.

If you enroll in original Medicare, you can buy a Medicare supplement, better known as a Medigap plan, from a private insurance company to help fill in the gaps.

But there’s a catch: If you don’t get the policy within a certain time frame, insurers in most states can reject you or charge more because of preexisting conditions. This limitation no longer exists for other kinds of health insurance.

To avoid this, find out when you can sign up and whether you might encounter any difficulties based on your health. Take the following steps to get the coverage you need:

1. Sign up at the right time

You can purchase a Medigap policy regardless of whether you have any preexisting conditions — known as a guaranteed issue right — during the following times:

For six months starting the month you sign up for Medicare Part B when you’re 65 or older. You’ll get the best price for any policy in your area based on your age, sex and smoking status.

Up to 63 days after you’ve lost job-based health insurance that’s considered secondary to Medicare. If you’re 65 or older and you or your spouse works for a company with fewer than 20 employees, the employer’s insurance is generally considered secondary to Medicare. You may sign up for Part B while you still have the employer’s coverage since Medicare is the primary coverage but delay signing up for Medigap until the employer’s coverage ends.

During a trial enrollment period. If you sign up for a Medicare Advantage plan when you first enroll in Medicare, you have up to 12 months to drop the plan, switch to original Medicare, and get any Medigap policy in your area. However, you forgo that trial right if you want to switch to a Medigap policy more than 12 months after enrolling in Medicare.

If you dropped a Medigap policy to enroll in Medicare Advantage and want to switch back to original Medicare. You have up to 12 months to get the same Medigap policy.

If you move out of your Medicare Advantage plan’s service area or your plan leaves the business.

Keep in mind that insurers can’t charge more or reject you because of your health. To learn more, read the Centers for Medicare & Medicaid Services’ Guide to Choosing a Medigap Policy.

2. Know your state’s rules

Three states — Connecticut, Massachusetts and New York — allow you to buy a Medigap policy anytime regardless of your health. The private companies that issue the policies also must charge everyone the same rate regardless of age, called community rating.

In these states, you can start out with a Medicare Advantage plan and pay lower premiums. Later, if you develop a health condition and want to use doctors and hospitals that aren’t in the plan’s network, you can switch to original Medicare and get a Medigap policy without having to pay more because of any preexisting conditions.

Maine requires insurers to offer Medigap Plan A, which offers the least amount of coverage, to anyone age 65 or older regardless of their health, for one month every year. The insurer decides which month.

Maine also extends the Medicare Advantage trial period from 12 months to 36 months. That means you have up to three years to switch back to original Medicare and get any Medigap policy.

Several states allow people who already have Medigap policies to switch plans without requiring them to answer questions about their health. Insurers in most states can offer up to 10 different plans, each labeled with a letter.

Plans with the same letter include the same benefits, but premiums can vary. You may be able to save money by switching to a different letter plan or a less expensive plan from a different insurer.

A birthday rule that allows you to change plans during a specified time around your birthday is law in several states.

In Oregon, you have 30 days after your birthday each year to switch to another Medigap plan with equal or lesser benefits. In California, you have 60 days after your birthday every year to do so.

As of Jan. 1, 2024, Kentucky residents will have up to 60 days after their birthday to switch to the same Medigap plan with a different insurer regardless of preexisting conditions. As of July 1, 2023, Marylanders can switch to another Medigap policy with equal or lesser benefits within 30 days after their birthday each year.

Illinois residents ages 65 to 75 can switch to another policy with the same insurer with equal or lesser benefits for up to 45 days after their birthday, a change that took effect in 2022.

In Missouri, you have up to 30 days before and 30 days after the anniversary of the date you purchased your policy to switch to the same letter plan with a different insurer.

In most states, insurance companies aren’t required by law to issue Medigap policies to people with preexisting conditions. However, some insurers, such as Blue Cross/Blue Shield in Illinois, offer some guaranteed issue plans.

Tricia Neuman, executive director of the program on Medicare policy at KFF (formerly the Kaiser Family Foundation), recently saw differences in state rules firsthand when helping two friends shop for Medigap policies.

One friend, in Pennsylvania, already had a Medigap policy and wanted to switch to another plan with fewer benefits to save money. If she didn’t have any health problems, the new plan each month would cost $100 less than her current plan. But because she lives in a state that allows insurers to charge more for preexisting conditions and she uses an inhaler for a lung condition, the insurer wanted to charge $100 more than her current plan.

The experience was very different for Neuman’s friend in New York.

“That same company allowed a 90-year-old I know to switch plans for a lower premium,” Neuman says. She didn’t have to answer any questions about her health.

To learn about your state’s rules, contact your State Health Insurance Assistance Program. Most state insurance departments have Medigap buyers’ guides that explain the rules and may even list premiums for each insurer.

Keep in mind that many of these rules apply only to people who are 65 and older. If you’re younger than 65 and have Medicare because of a disability, you may have a more difficult time qualifying for coverage. The pre-65 Medigap rules vary significantly by state.

3. Shop for an insurer that will cover your medical condition

When you apply for a Medigap policy and don’t have a guaranteed issue right, you’ll usually have to answer questions about your health. Steve Jones, president of Cigna supplemental benefits, says insurers typically don’t ask to see your medical records, but they usually ask about your prescription medications.

“Insurers may ask if a doctor treated you, gave you medical advice or prescribed any medications for certain conditions in the last two years,” says CEO Joanne Giardini-Russell of Giardini Medicare, an independent insurance agency in Howell, Michigan.

Having one of the following conditions in the past two years could increase the rate you’ll pay for a Medigap policy, depending on the insurer:

Artery or vein blockage

Atrial fibrillation

Cancer

Cardiomyopathy

Chronic kidney disease

Chronic obstructive pulmonary disease (COPD)

Congestive heart failure

Multiple sclerosis

Rheumatoid arthritis

Insurers usually decline people who have COPD, lupus or Parkinson’s disease or were recently diagnosed with cancer, Giardini-Russell says. Other conditions, such as high blood pressure, diabetes and high cholesterol, may be acceptable. But you may have to pay a higher rate.

You also may be asked if a medical professional prescribed any of the following procedures: joint replacement, organ transplant, cancer surgery, back or spine surgery, or heart or vascular surgery. Some insurers may deny coverage if you’ve been hospitalized in the past 90 days or if you live in a nursing facility.

However, timing and the nature of your medical condition are important. If you were diagnosed with cancer or had surgery a while ago, you may still be able to buy a policy.

“If a person had knee replacement eight months ago and is done with physical therapy, they will generally be accepted as long as they don’t have any other health problems,” Giardini-Russell says.

Some insurers are more lenient than others.

“Underwriting varies considerably from one company to another,” Bonnie Burns, a consultant with California Health Advocates, says about pricing and decisions on whether to issue a policy.

Depending on a person’s health, Cigna may offer a lower, also called a preferred, rate or a slightly higher standard rate. For major health issues, an insurer may offer different versions of a policy at a higher rate or it may reject the applicant.

If you’re trying to get a Medigap policy when you don’t have a guaranteed issue right and you have preexisting health conditions, you might consider getting help from an independent agent who works with several companies and knows the underwriting criteria.

“It can avoid a lot of frustrations,” Giardini-Russell says. “I recently told a woman who has lupus that if she didn’t get Medigap right out of the gate, there was a good chance she might not be able to get it in the future.”

For a list of insurers that sell Medigap policies in your area, visit Medicare’s Medigap plan finder.

This story, published Dec. 6, 2021, has been updated with new information.

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Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

3 Ways to Avoid Being Rejected or Overcharged for a Medigap Policy

Knowing when to sign up can help you get the coverage you need

1. Sign up at the right time

2. Know your state’s rules

3. Shop for an insurer that will cover your medical condition

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