When Medicare Supplement Companies
Can Deny Your Coverage
Understanding your rights and when insurance companies must accept your application can save you from coverage denials and higher premiums.
Quick Answer: It Depends on Timing
They CANNOT deny you during your 6-month Open Enrollment Period when you turn 65, or during special guaranteed issue situations.
They CAN deny you outside these protected periods due to health conditions, pre-existing conditions, or medical history.
🛡️ Understanding these rules is crucial to avoid being locked out of Medigap coverage.
When Companies CANNOT Deny You
Guaranteed Issue Rights
Federal Legal Protection
Open Enrollment Period (Most Important)
6 months starting when you turn 65 AND enroll in Medicare Part B
- • No health questions allowed
- • Cannot deny for any reason
- • Cannot charge higher premiums
- • Must sell any plan they offer in your state
Losing Other Coverage
When group coverage ends (63-day window)
- • Employer insurance ends
- • COBRA expires
- • Union coverage terminates
- • Spouse's coverage ends (divorce/death)
Medicare Advantage Problems
When your MA plan has issues
- • Plan leaves Medicare
- • Plan stops serving your area
- • Plan violates Medicare contract
- • Trial right (switching back to Original Medicare)
Special Situations
Additional Protections
Working Past 65
Delayed Medicare due to employer coverage
- • 6-month window starts when you enroll in Part B
- • Not when you turn 65
- • Must have creditable coverage
Disability Medicare
Special rights at age 65
- • New 6-month open enrollment at 65
- • Even if you've had Medicare for years
- • Can switch from current Medigap plan
State-Specific Rights
Some states provide extra protections
- • California: Birthday Rule
- • Oregon: Birthday Rule
- • Other state programs vary
⚠️ Critical Timing Rules
Most guaranteed issue rights have strict deadlines - typically 63 days from losing coverage. Missing these deadlines means you'll face medical underwriting and possible denial.
When Companies CAN Deny You
Medical Underwriting
Outside Protected Periods
Outside of guaranteed issue periods, insurance companies can use medical underwriting to decide whether to accept your application.
When This Applies
- • After your 6-month open enrollment period
- • No qualifying guaranteed issue event
- • Switching plans outside protected periods
- • First-time Medicare enrollment after age 65
Health Questions They Ask
- • Current medications
- • Recent hospitalizations
- • Chronic conditions
- • Scheduled procedures
- • Doctor recommendations
Common Denial Reasons
Health-Based Decisions
High-Risk Conditions
- • Heart disease or recent heart attack
- • Cancer (current or recent treatment)
- • Kidney disease or dialysis
- • Stroke or neurological conditions
- • Diabetes with complications
Recent Medical Events
- • Hospitalization in past 6 months
- • Scheduled surgery or procedures
- • Recent diagnosis of serious condition
- • Doctor-recommended tests pending
Alternative Outcomes
- • Outright denial
- • Higher premiums (rate-ups)
- • Exclusion riders for specific conditions
- • Waiting periods for pre-existing conditions
Coverage Timeline: What Changes When
Turning 65 & Enrolling in Medicare Part B
6-Month Guaranteed Issue Period Begins
What You Can Do:
- • Buy any Medigap plan sold in your state
- • No health questions
- • No medical exams
- • Cannot be denied
- • Standard pricing
Time Limit:
Exactly 6 months from the first day of the month you turn 65 AND have Part B coverage.
After 6-Month Period Ends
Medical Underwriting Begins
What Changes:
- • Must answer health questions
- • May require medical exams
- • Can be denied for health reasons
- • May face higher premiums
- • Exclusion riders possible
Still Available:
You can still apply, but acceptance isn't guaranteed and you may pay more or have conditions excluded.
Special Guaranteed Issue Events
Protection Returns Temporarily
When you lose other coverage or have Medicare Advantage problems, you get temporary guaranteed issue rights again.
⚠️ Usually limited to 63 days from the qualifying event
State-Specific Protections
California
Birthday Rule
Within 30 days of your birthday, you can switch to a plan with equal or lesser benefits without underwriting.
Additional Rights
Continuous open enrollment for certain plans and situations.
Oregon
Birthday Rule
Similar to California - annual opportunity to switch to equal or lesser benefits.
Open Enrollment
Some additional open enrollment opportunities beyond federal requirements.
Other States
Federal Rules
Most states follow federal guaranteed issue rules with limited additional protections.
Check Locally
Some states may have additional consumer protections not widely advertised.
What You Should Do
If You're Approaching 65
Don't delay! Start shopping during your 6-month guaranteed issue period. This is your best and possibly only chance for guaranteed coverage.
✓ Apply even if you're healthy - rates and acceptance won't get better
If You Missed Your Window
You can still apply, but be prepared for medical underwriting. Consider applying to multiple companies as each has different underwriting guidelines.
⚠️ Work with an experienced agent who knows carrier-specific underwriting
If You Have a Qualifying Event
Act quickly! Most guaranteed issue rights expire 63 days after the qualifying event. Document everything and apply immediately.
🕒 Time limits are strictly enforced - don't wait
Related Articles
Medicare Supplement Open Enrollment Guide
Critical differences between enrollment periods and when you can enroll.
Plan G vs Plan N Cost Analysis
Complete cost comparison to help you choose the right Medigap plan.
Understanding Guaranteed Issue Rights
Detailed guide to all guaranteed issue situations and timing requirements.