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Can My Medicare Supplement Insurance Plan Deny My Coverage?

Summary: A Medicare Supplement insurance plan may not deny coverage because of a pre-existing condition. However, a Medicare Supplement plan may deny you coverage for being under 65.

A health problem you had diagnosed or treated before enrolling in a Medicare Supplement plan is a pre-existing condition. These might include an injury or disease like asthma or high blood pressure. You might be getting treatments now or have had them in the past.

Sometimes, you can enroll in a Medicare Supplement insurance plan with a pre-existing condition. Other times, plans can deny coverage or charge more. When you apply for a plan affects how your coverage works.

What are Medicare Supplement Insurance Plans?

Private insurance companies offer Medicare Supplement insurance plans. You can enroll in a Medicare Supplement insurance plan if you have Original Medicare. Medicare Supplement Insurance plans cover costs like copayments and deductibles that are not covered by Original Medicare.

A plan might offer services in addition to Original Medicare. One example is medical care in other countries. Medicare Supplement Insurance plans generally do not cover services like prescription medications or vision and dental care.

Enrollment Periods for Medicare Supplement Insurance Plans

You have different times to sign up for a Medicare Supplement insurance plan:

Open Enrollment

The best time to sign up for a Medicare Supplement insurance plan is generally during your open enrollment period. Open enrollment begins the month you turn 65 and are enrolled in Medicare Part B. You have six months to sign up for a plan. Insurance companies cannot deny coverage or charge more for a pre-existing condition during your open enrollment period.

Outside Open Enrollment

You can also apply for a Medicare Supplement insurance plan outside open enrollment. An insurance company must offer you coverage during this time if you have a guaranteed issue right. Guaranteed issue rights are also known as Medigap protections. They protect you if you have a pre-existing condition.

The insurance company may deny coverage or charge you more without a guaranteed issue right. Even if you enroll in a plan, you may have to wait for your health condition to be covered. This coverage gap is known as a pre-existing condition waiting period.

Understanding Guaranteed Issue Rights

You generally have guaranteed issue rights when your current insurance coverage stops or changes. For example:

  • You might lose coverage if you move out of your plan’s service area.
  • Your Medicare Advantage or Medicare supplement plan might also go bankrupt or change service area.
  • You might leave an employer who was providing insurance coverage.

If one of these situations occurs, you can sign up for a Medicare Supplement insurance plan before your current coverage ends. If you sign up early, you won’t have any breaks in your coverage. If you sign up after your coverage ends, you generally need to do so within 63 days.

Understanding Pre-Existing Condition Waiting Periods

A Medicare supplement insurance plan may not deny coverage because of a pre-existing condition if you meet other eligibility requirements. However, it might require you to wait for coverage to begin for that condition. The waiting period can last up to six months and will only apply to the conditions you had before your Medicare supplement insurance plan coverage began.

During the waiting period, you will typically be covered for all medical care except services for your pre-existing condition. Your pre-existing condition will be covered under Original Medicare during the waiting period. However, your Medicare Supplement plan will not cover this condition during that time. When the waiting period is over, your condition will be covered under your Medicare Supplement plan.

Finding Medicare Supplement Insurance Plans

Are you shopping for a Medicare supplement insurance plan? Our online comparison tool can help. Type in your zip code now to see plans in your area. You can also contact one of our licensed agents with questions.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. The product and service descriptions, if any, provided on these Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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