Medigap Underwriting: When You Can Be Turned Down

Medigap underwriting is the health review an insurance company uses to decide whether to sell you a Medicare Supplement policy and what to charge. During your six-month Medigap Open Enrollment Period, insurers are barred from using it. After that window closes, they are allowed to.

That single switch is the whole subject. The coverage does not change, the standardized plan letters do not change, but your ability to buy at all does.

Outside a protected window, an insurer can look at your health history and decline your application. That is why the timing of a Medigap purchase matters more than the price you find on the first quote.

The window that protects you

Federal law gives you one clear opportunity to buy Medigap without health underwriting. Medicare calls it the Medigap Open Enrollment Period, and describes it as a six-month window that starts the first month you have Medicare Part B and you are 65 or older.

Inside that window, underwriting is prohibited outright. Medicare states that you can enroll in any Medigap policy, that an insurance company cannot refuse to sell you any of the medical policies it offers, and that insurers cannot use medical underwriting to decide whether to accept your application or deny you coverage due to pre-existing health problems. They also cannot charge more because of pre-existing health problems.

Inside that window, insurers must sell you any Medigap policy they offer in your state. The page's answer for a reader in that position is direct: you have the right to buy any Medigap policy that is sold by an insurance company in your state.

Outside it, all three protections fall away at once. Medicare is direct about the consequence: the insurance company is allowed to deny you a policy if you do not meet their medical underwriting requirements. It also warns that you may have to pay more and that fewer policy options may be available.

Medicare states plainly that the Medigap Open Enrollment Period is a one-time enrollment period that does not repeat every year, unlike the annual Medicare Open Enrollment Period. That difference is the most common confusion in this topic.

Two timing details are easy to miss and both are consequential.

First, the window starts with Part B, not with your birthday. Medicare states that if you delay signing up for Part B because you have group health coverage based on your or your spouse's current employment, your Medigap Open Enrollment Period will not start until you get Part B. Working past 65 therefore postpones the window rather than forfeiting it. Our guide to working past 65 covers that delay decision.

Second, the window is six months and does not renew. It is not the annual fall enrollment period, and it does not reopen because you change Medicare Advantage plans.

What underwriting actually looks at

Medigap underwriting is medical underwriting: a review of your health history to decide whether to accept you and at what rate. When Medicare describes the consequence of missing the window, it points to exactly that: options may be limited, the policy may cost more, and past or present health problems can be the reason.

The practical implication is that the specific conditions and medications that make you a good or poor risk vary by insurer. Two carriers can reach different decisions on the same applicant, and premium rating can differ by insurer for identical coverage. Medicare makes the coverage-identical point separately, noting that costs can vary between plans offered by different companies for exactly the same coverage, because Medigap policies are standardized by letter.

That standardization is what makes shopping possible: a Plan G from one insurer covers what a Plan G from another covers, so the decision reduces to price, service, and the underwriting outcome.

The protected situations beyond the initial window

Federal law does not leave everyone unprotected after six months. Medicare lists specific guaranteed-issue rights, and the pattern is that each is tied to losing coverage you had, rather than to wanting a different policy.

Several of these share a common rule worth memorizing. If you are leaving a Medicare Advantage plan to return to Original Medicare, or replacing one Medigap policy with another, the application generally has to be made 60 days before the date your coverage ends and no more than 63 days after your coverage ends.

The situations Medicare's page identifies include:

• A Medicare Advantage plan ending or you moving out of its service area. You have the right to buy Medigap Plan A, B, K, or L from an insurer in your state, or in some cases the policy you had before.
• A trial right. If you joined a Medicare Advantage plan when you first became eligible for Medicare and decide within the first year that you want Original Medicare, Medicare states you have the right to buy any Medigap policy sold in your state.
• Losing employer or union coverage or a retiree plan. Medicare describes a right to buy, with the same 60-day and 63-day application windows and a note that your rights may last an extra 12 months in certain circumstances.
• A Medigap policy ending through no fault of your own. You have 63 days after your current Medigap coverage ends to buy a new policy, and you may need the letters or notices proving the coverage ended.
• Losing Medicaid or a Medicare Advantage plan that is leaving Medicare. Each carries its own described right.

Two cautions. Medicare's rights page opens by stating that these answers only apply to your federal rights and directs readers to contact their state to find out whether it offers more opportunities. And the main buying page repeats the point about guaranteed issue situations, advising you to check with your State Insurance Department to see if you can buy a Medigap policy outside of your Medigap Open Enrollment Period, because you may have additional rights under state law.

The state layer you cannot skip

Medicare repeats the state caveat throughout, and it is not boilerplate. Several of the exceptions to underwriting exist only in state law.

The clearest example concerns people under 65. Medicare states that federal law generally does not require insurance companies to sell Medigap to people under 65, and that if you are under 65 you might not be able to buy the policy you want, or any policy, until you turn 65. But it immediately adds that some states require Medigap insurance companies to sell Medigap policies to people under 65, and that a policy bought that way may cost more.

Other state variations Medicare flags include additional Open Enrollment Periods and, in three states, a completely different standardization scheme. The handbook notes that in Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

Because NavaQuote is licensed in Arizona, Colorado, Georgia, Florida, North Carolina, South Carolina, and Texas, those are the state rules most relevant here. The article does not attempt to summarize any of them, because state Medigap rules change and a summary would go stale. Confirm with your state insurance department.

Two structural limits worth knowing

Two Medigap facts affect who can buy at all, and they are separate from underwriting.

You generally cannot buy Medigap while you have a Medicare Advantage plan. Medicare states that if you are in a Medicare Advantage Plan, it is illegal for anyone to sell you a Medigap policy unless you are switching back to Original Medicare, and it tells readers to report such an attempt to the state insurance department.

You generally cannot buy Medigap if you have Medicaid. Medicare states that insurance companies generally cannot sell you a Medigap policy if you have Medicaid coverage, even if you have both Medicare and Medicaid.

There is also a rule about which plans exist for whom. Medicare notes that you cannot buy Medigap Plans C or F if you became eligible for Medicare on or after January 1, 2020. If a sales presentation offers you Plan F and you turned 65 recently, that is a signal the presentation is not tailored to you.

What to check before you apply

Work through this in order, because later questions depend on earlier answers.

• Establish whether you are inside the Medigap Open Enrollment Period. It starts the first month you have Part B and are 65 or older. If you delayed Part B for employer coverage, it has not started yet.
• If you are past the window, check whether you fit a federal guaranteed-issue situation, and check the 60-day and 63-day application windows carefully, because they are short.
• Check your state's rules. Some states add protections, add open enrollment periods, or require issuance under 65.
• Confirm you are not barred from buying. You generally cannot buy Medigap while enrolled in Medicare Advantage or while you have Medicaid.
• Compare identical letters across insurers. Coverage is standardized, so price and underwriting outcome are the variables.
• Do not drop existing coverage before the new policy is in force. Medicare warns that if you drop Medigap to join a Medicare Advantage plan, you might not be able to get your Medigap policy back or you might have to pay more depending on state rules.
• Keep every notice, letter, email, or claim denial that documents coverage ending, because Medicare notes you may need copies to prove you have the right to buy a new policy.

One cost note that belongs beside the underwriting discussion: a Medigap policy covers one person, so spouses must buy separate coverage. A household budget for Medigap has to double the individual premium, not share it.

If you are approaching the end of your protected window and want to compare Medigap policies before it closes, ask NavaQuote about your Medicare options. Bring your Part B start date, your current coverage, your doctors, and any health conditions an insurer may ask about. Our Advantage versus Supplement guide explains the coverage paths, and our Medicare enrollment periods guide covers the enrollment windows that are often confused with the Medigap window.

Premium amounts and plan availability change annually and vary by state. Confirm the current year's figures and your state's rules before relying on either.