Last Updated on April 2, 2019
Nothing can put you on the pits than knowing that you got escalating healthcare expenses.
That puts your bread on the line!
So, what am I rapping about?
I am talking about the importance of having the right option to cover your healthcare expenses. If you are looking for health coverage, either to go with your Medicare or just in need of backup protection, it is important to explore your options.
One of the options that you will encounter is the Medicare supplement plan (Medigap).
What is Medicare supplement plan?
It is an additional health insurance plan sold by private insurance companies that pay for out-pocket expenses not covered by Medicare.
It can minimize the risk of facing heavy out-of-pocket healthcare expenses. Medigap covers all or part of deductibles, copayment and also coinsurance. Except for Massachusetts, Minnesota, and Wisconsin, all 47 states offer ten standardized plans of Medigap.
Fact: 1 in 4 people in traditional Medicare had a Medigap policy in 2015.
Also, check this out:
Medicare supplement plans offer these far out benefits:
- Medicare Part A coinsurance and coverage for hospital services
- Hospice care coinsurance or copayment
- Medicare Part B coinsurance or copayment
- Blood transfusions (first three pints)
Some types of Medigap has these additional coverage shown in the image below.
However, before you skedaddle to buying a Medigap insurance, you should know that it has eligibility requirements.
Now, I know you start to question yourself…
Can I be denied a Medicare supplement plan?
Yes! There are certain situations that your application of Medigap coverage is rejected. The good thing about knowing about these situations is that it will help you plan as to what will be your next action.
If you are already a Medicare beneficiary, there are limited circumstances in which you can be declined of a Medicare supplement insurance.
Your Medicare supplement plan application can be turned down if you:
1. Are not enrolled in Medicare Part A and Part B.
One of the basic requirements to be eligible to enroll in a Medigap plan is to have Medicare Part A and Part B. Your application won’t be accepted if you lack either of the parts. You must have both Medicare Part A and Part B before you can qualify for a Medigap policy.
2. Have both Medicare Part A and Part B, but are still under 65.
Also, one of the basic requirements to be eligible in a Medicare supplement is being aged 65 or above. If you acquire Medicare before you turn 65 because of ESRD (end-stage renal disease) or ALS (amyotrophic lateral sclerosis), it might be grounds that your application won’t be accepted.
OK, this part might have frustrated you, especially if you belong to this group.
But you should know that there are some states that require insurance companies to sell Medigap policies to people under age 65. However, you may still be denied in certain circumstances such as if you have ESRD.
Medigap plans are expensive if you will get it while you are still not 65.
If you have a pre-existing health condition, better read the next point.
3. Miss your Medigap open enrollment period.
Your Medicare supplement open enrollment period is a critical period wherein you can enroll in any Medigap plan you like without being rejected or denied – even if you have pre-existing conditions!
Yes, you read it right!
During this period, you will have guaranteed issue rights. This right allows you to enroll in any Medigap plan you like without the need to undergo medical underwriting. Also, insurance companies can’t reject your application or charge you with higher premiums because of your medical condition.
So, if you miss your enrollment period, you may have to undergo medical underwriting. You may be rejected or be denied a Medigap plan during this time, especially if you have pre-existing conditions.
Didn’t the Affordable Care Act (ACA) was created to provide protection for those with a pre-existing condition?
Yes, however, Medicare supplement plans are not among that protection. Sorry.
4. Have any Medicare Advantage plan or Medicare Medical Savings Account (MSA).
Fact: You can’t have both plans!
Medigap works with Original Medicare and are not designed to work with a Medicare Advantage Plan. Most importantly, it is illegal to sell you a Medicare supplement while you are still on an Advantage Plan or MSA.
What you can do is:
To apply for a Medicare supplement plan and promise that you will drop your Medicare Advantage plan. If insurer accepts your application, your Medigap plan will begin once your previous plan ends.
You can still be denied if you have pre-existing conditions.
5. State rules
Different states imposes different Medicare supplement rules.
Of all the states, only four provide guaranteed issue rights to Medicare beneficiaries 65 or older either continuously or at least one month in a year. These states are Connecticut, Maine, Massachusetts, and New York.
Circumstances to which you can be denied a Medicare supplement policy is not limited to the five situations given above. It is there to provide you with the idea of what basic or common circumstances that you may not qualify for a Medigap. You can use the knowledge to plan ahead and make actions so insurance companies won’t reject your application.
But wait there’s more!
Before you lose hope, know that there are also certain circumstances that you won’t be denied of a Medigap plan.
Are there any chances I could still enroll in a Medigap plan and get accepted?
Yes! There are circumstances where you can still have a Medigap plan and won’t be denied.
Remember the guaranteed issue rights that I mentioned earlier? You’ll be able to have it again in certain situations.
You can have it again, if you:
- Have a Medicare Advantage plan and that plan is leaving Medicare.
- Have Medicare Advantage plan but that plan stops giving care in your area.
- Are moving to a different location and out of your Medicare Advantage plan’s service area.
- Have an employer group plan (including retiree or COBRA coverage) or union coverage that pays after the Original Medicare pays that is ending soon.
- Move out of Medicare SELECT policy’s service area (for those with Original Medicare and a Medicare SELECT policy).
- Have a trial right. This happens when you:
- Enroll in Medicare Advantage plan or Programs of All-inclusive Care for the Elderly (PACE) when you first eligible for Medicare Part A at age 65. Then within the first year of joining, you want to switch back to Original Medicare.
- Leave your Medicare supplement policy to join a Medicare Advantage plan or switch to Medicare SELECT policy. You’ll have the trial right, if this is your first time and are in the plan for less than a year and decide you want to switch back.
- You lose your coverage because your Medicare supplement insurance provider goes bankrupt.
- Your Medicare supplement policy ends but you are not at fault.
- The insurance company provider of your Medicare Advantage plan or Medigap plan did not follow the rules or misled you.
If it happens that more than one of the situations applies to you, choose the guaranteed issue rights that will provide you the best choice.
It is hard not to be bummed out by health care expenses. Know that there are coverage and options that will help you bug out of the stressful situation. Hang lose and start looking at your options. If you are worried about getting denied of a Medigap plan, we can help you. Request for Medicare supplement plan quotes from us, and one of our licensed Medigap experts will reach out to you.