How Medigap Insurance Is Affected by Preexisting Conditions

Medigap plans, also called a Medicare Supplement Insurance, are sold by private companies, and can help pay some of the health care costs Original Medicare doesn't cover, such as copayments and deductibles. 

Unlike Medicare, there are circumstances when insurance companies can factor in preexisting conditions when deciding whether to offer you a medigap policy or when setting the premiums.

Medigap open enrollment only happens once

You get a six-month “Medigap Open Enrollment” period that starts the first month you have Medicare Part B and you’re 65 or older. During this period you have what is called guaranteed issue rights that protect you from denial of coverage for preexisting conditions and higher premiums. An insurance company can’t use medical underwriting to decide whether to accept your application or upwardly adjust your costs. 

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An insurer can deny you coverage if you don’t meet their medical underwriting requirements, you may have to pay more and there may be fewer options for you to consider after your medigap open enrollment period is over.  

How preexisting conditions can affect your medigap eligibility 

Many people don’t realize that even though preexisting conditions can’t affect your ability to get other types of health insurance, such as Medicare, the rules are very different for medigap policies.

You can pick any medigap plan available in your area within six months after you initially sign up for Medicare Part B. But after that, medigap insurers in almost all states can reject you or charge more based on your health. 

This can make it difficult if you’d like to switch to another insurer with better medigap rates or if you had a Medicare Advantage plan for more than a year and want traditional Medicare and a medigap policy instead.

States where insurers can't deny medigap coverage after your initial enrollment period

There are a few exceptions. Four states — including Connecticut, Maine, Massachusetts and New York — have special rules that let residents switch medigap plans regardless of preexisting conditions. 

Other states permit you to change plans at certain times. For example, Californians may select a different medigap plan that has the same or fewer benefits if they make the choice within 30 days after their birthday each year. You may also buy a medigap policy without concern about preexisting conditions if you move out of your Medicare Advantage plan’s service area or change your mind within 12 months of signing up for Medicare Advantage at age 65. For more information see Medicare.gov’s When Can I Buy Medigap?

Also, your insurer may let you switch to a less-comprehensive policy regardless of your health (such as switching from a Plan F to a high-deductible Plan F, for example). See the Medicare Rights Center’s list of what each type of medigap policy covers.

And if you’re healthy, you may still be able to qualify for a new medigap policy, especially if you’re in your mid-to-late sixties. You don’t need to wait until any specific time of year to apply for a new medigap policy because there is no annual open-enrollment period.

Resources to help find a medigap policy

For more information about your state’s rules, see your state insurance department website. You can find links at www.naic.org/map. Most have consumer guides that list medigap prices and provide information for seniors searching for a plan. Your State Health Insurance Assistance Program can also help. See www.shiptacenter.org for links.

• Medicare Basics: 11 Things You Need to Know
• What’s the Best Medigap Plan?
• The Rules for Making a Medigap Switch