Can You Be Turned Away from a Medigap Plan? Know the Rules

When planning for retirement and healthcare, a common concern among Medicare beneficiaries is: “Can you be denied a Medicare Supplement plan?” As 2025 unfolds, understanding the rules, rights, and potential roadblocks around Medigap—another term for Medicare Supplement plans—is more important than ever.

Medicare Supplement plans are designed to cover the “gaps” left by Original Medicare (Part A and Part B). These gaps can include copayments, coinsurance, and deductibles. However, these plans are sold by private insurance companies, and with that comes underwriting, enrollment periods, and eligibility rules that can sometimes lead to Medicare Supplement denial.

In this comprehensive guide, we’ll answer the crucial question: Can you be denied a Medicare Supplement plan in 2025? We’ll also explore the circumstances under which denial is possible, how pre-existing conditions affect eligibility, how underwriting works, and what alternatives or rights you may have.

What Are Medicare Supplement Plans (Medigap)?

Medicare Supplement plans, also known as Medigap policies, are standardized plans sold by private insurers to help pay healthcare costs not covered by Original Medicare. These include:

• Deductibles

• Coinsurance

• Copayments

• Emergency foreign travel coverage

There are 10 standardized Medigap plans (A, B, C, D, F, G, K, L, M, and N), although Plan F and Plan C are no longer available to new Medicare beneficiaries who became eligible after January 1, 2020.

These plans do not include prescription drug coverage, so you’ll need a separate Medicare Part D plan for medications.

Can You Be Denied a Medicare Supplement Plan?

The Short Answer: Yes, You Can Be Denied—But Only in Certain Situations

While guaranteed issue rights protect you during specific periods, outside those times, insurers can deny you a Medicare Supplement plan or charge more based on your health status.

Let’s break it down:

When You Cannot Be Denied: The Medicare Supplement Open Enrollment Period

Your best chance to get a Medicare Supplement plan without denial is during your Medigap Open Enrollment Period (OEP):

• Begins the first month you’re 65 or older and enrolled in Medicare Part B

• Lasts 6 months

During this period:

• You cannot be denied coverage for any reason, including pre-existing conditions

• Insurers must sell you any plan they offer

• No medical underwriting is required

This period offers guaranteed acceptance, and it’s the ideal time to apply.

Can You Be Denied Outside the Open Enrollment Period?

Yes. Once your Medigap Open Enrollment Period ends, you may have to undergo medical underwriting if you apply for a plan. This means the insurance company:

• Reviews your medical history

• May request health screenings

• Can deny your application based on your current or past health conditions

Key health conditions that may cause denial include:

• Congestive heart failure

• Recent cancer diagnosis

• Chronic kidney disease

• Insulin-dependent diabetes

• Alzheimer’s or dementia

• Severe mental illness

What About Pre-Existing Conditions?

Can Medicare Supplement plans deny for pre-existing conditions?

Yes, but only outside of your Open Enrollment Period or if you don’t have guaranteed issue rights.

However, even if you’re accepted, a waiting period may apply. Insurers can delay coverage for pre-existing conditions for up to six months unless you had creditable coverage before applying.

What Is Medical Underwriting?

Medical underwriting is the process by which insurance companies assess your health risks. They use this information to:

• Approve or deny your application

• Set your premiums

• Impose waiting periods

If you’re applying for a Medigap policy outside your OEP and don’t have guaranteed issue rights, you’ll likely go through underwriting.

Are There Any Plans Without Underwriting in 2025?

Is it possible to get a Medicare Supplement plan with no underwriting?

Yes, but only under specific circumstances, such as:

• During your Initial Enrollment Period

• When you have guaranteed issue rights

• If your state offers continuous open enrollment (e.g., New York, Connecticut, Maine)

• Certain insurers may offer “no underwriting promotions” for limited times

Guaranteed Issue Rights: When Can You Not Be Denied?

Guaranteed issue rights mean that insurance companies must sell you a Medigap policy, must cover your pre-existing conditions, and can’t charge you more due to past or current health issues.

Common situations that grant guaranteed issue rights:

• Your Medicare Advantage plan leaves Medicare

• You move out of your plan’s service area

• Your employer coverage ends

• Your Medigap insurer goes bankrupt

• You try a Medicare Advantage plan for the first time and switch back to Original Medicare within 12 months

State-Specific Rules in 2025

Some states offer additional protections for Medicare Supplement (Medigap) enrollment, providing more flexible periods and even banning medical underwriting altogether:

• New York: Continuous Open Enrollment — can’t be denied year-round.

• Connecticut: Continuous Open Enrollment — no medical underwriting.

• Massachusetts: Special guaranteed issue periods and standardized plans.

• California: Birthday Rule — switch Medigap plans annually around your birthday.

• Oregon: Birthday Rule applies.

• Missouri: Anniversary Rule — switch to an equal or lesser plan each year.

Always check with your State Health Insurance Assistance Program (SHIP) for the latest protections and regulations.

What If You’re Under 65 with Medicare?

Some individuals qualify for Medicare before 65 due to disability. Unfortunately, Medigap protections are not federally guaranteed for those under 65.

However, many states have laws that require insurance companies to offer at least one Medigap plan to individuals under 65. These plans are often more expensive, and underwriting rules may vary.

Can a Doctor Refuse a Medicare Supplement Plan?

Can a doctor refuse a Medicare Supplement plan?

No, not directly. Doctors do not accept or refuse Medicare Supplement plans—they either accept Medicare assignment or they don’t.

If your doctor accepts Original Medicare, they will also accept any Medigap plan because Medigap simply pays the portion Medicare doesn’t.

What Happens If You’re Denied a Medicare Supplement Plan?

If you’re denied, you can:

1. Apply with another insurer – Underwriting policies differ

2. Consider a Medicare Advantage plan – These plans often don’t require underwriting

3. Wait for a guaranteed issue period – Like dropping employer coverage or moving

4. Appeal the decision – Especially if you believe it was made in error

Alternative Options to Medigap in 2025

If you’re denied Medigap coverage or find the premiums unaffordable, here are some alternatives:

Medicare Advantage (Part C)

• Low or $0 premiums

• Includes drug coverage

• Limited provider networks

• Often includes vision, dental, and wellness perks

Medicaid

• For those with limited income and assets

• Can work alongside Medicare (dual eligibility)

PACE (Program of All-Inclusive Care for the Elderly)

• Integrated Medicare and Medicaid services for those 55+

Important Tips for 2025 Applicants

• Enroll early to avoid underwriting

• Maintain continuous coverage to avoid pre-existing condition penalties

• Shop around—some insurers are more lenient than others

• Use state-specific enrollment opportunities

Frequently Asked Questions (FAQs)

Can you be declined for a Medicare Supplement?

Yes, you can be declined if you apply outside your Open Enrollment Period and do not have guaranteed issue rights. Insurers can deny coverage based on health history.

Can a doctor refuse a Medicare Supplement plan?

No. If your doctor accepts Medicare, they must also accept any Medigap plan since it only supplements Original Medicare payments.

Can Medicare Supplement plans deny for pre-existing conditions?

Yes, outside of the Open Enrollment Period or without guaranteed issue rights, you can be denied or face a waiting period for coverage of pre-existing conditions.

Is it possible to get a Medicare Supplement plan with no underwriting?

Yes, but only during Open Enrollment, through guaranteed issue rights, or in certain states that have continuous enrollment laws.

Final Thoughts

Protecting Your Medicare Rights in 2025

So, can you be denied a Medicare Supplement plan in 2025? The answer depends on when and where you apply, your health condition, and your state’s laws.

Here’s what to remember:

• Apply during your 6-month Medigap Open Enrollment Period to avoid denial or underwriting.

• Be aware of your guaranteed issue rights and use them wisely.

• Understand your state’s protections, especially if you’re under 65 or applying late.

• If denied, don’t panic—alternatives like Medicare Advantage can still provide comprehensive coverage.

Health is unpredictable, but your Medicare coverage doesn’t have to be. With the right timing, knowledge, and support, you can secure the Medigap plan that best suits your needs and avoids unnecessary stress down the line.

Medicare made easy—compare, choose, and save! Get your free quote at NewMedicare.com or 📞 833-203-6742.

Katelin Young

With a genuine passion for Medicare and healthcare, I become a dedicated and informed writer. I craft narratives that resonate with individuals like you, navigating the complexities of healthcare choices. Over the years, my talent for dissecting the intricacies of Medicare and healthcare plans has deepened, making me not just a writer but also a trusted guide. I'm here to empathize with you as you explore your healthcare options. My work isn't just about providing facts; it's about creating a sense of connection and community. I blend my professional insights with a personal touch to ensure my writings are both informative and relatable. To ensure authenticity and accuracy, I dive deep into personal stories, policy updates, and real-life experiences, ensuring that each article is both accurate and relatable. Please note I'm AI-Katelin, an AI-enhanced writer. Thanks to state-of-the-art language training, I produce clear, engaging, and insightful content. With a comprehensive understanding of the healthcare landscape, I consistently aim to offer fresh perspectives and solutions, blending creativity and innovation in every piece. Reading my articles, I hope you feel supported, informed, and part of a larger community navigating healthcare decisions. I intend to assure you that you're not alone in your Medicare journey. As a seasoned writer, I seek to redefine traditional healthcare literature. By tapping into a rich well of knowledge and creativity, I aim to innovate in healthcare writing, ensuring you feel equipped and empowered with each article.

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