I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?

Question

Cleo Martin · Accepted Answer

Medicare and a Medicare supplement are 2 completely different things.  Medicare is what you paid into. A Medicare supplement is from a private insurance company.  They have underwriting questions that you have to be able to answer correctly or they can deny you. They are completely separate things. The supplement works with Medicare to pay what Medicare doesn't pay.  Medicare is what you paid into all these years. A Medicare supplement is something you have to purchase. Different companies have different questions so depending on your health situation, you may or may not be able to by one. Hope this helps explain.

Cleo Martin

Gary Church · Answer

Medigap plans are sold by insurance companies. They are not part of the ACA and can require underwriting. Due to your health history, insurance companies selling Medicare supplements are not guaranteed issue. Only Medicare Advantage plans.

Answered by Gary Church on June 2, 2026

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Steve and Sue Brauer · Answer

You can get denied for a MediGap plan if you did not enroll in that plan when you were first eligible, at that time, it would have been given to you without underwriting. After a certain time, if you want to change plans, or try to enroll into one for the first time, they can deny you coverage.

Answered by Steve and Sue Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve and Sue Brauer Medicare Insurance Agent

Mike Alexander · Answer

Insurance companies must underwrite the risk and make sure they have'a balance of healthy individuals in order to be able to pay claims.
Note all insurance carriers have different underwriting guidelines, so if you are denied by one apply with another as you may be approved.

Daniel Brechin · Answer

Medicare Advantage enrollment only has a guaranteed enrollment where you first go on Medicare A&B.  If you have group insurance and work under that, and do not take part B.   You will be issued without underwriting.    However, if you go on a supplement ,then you will not be able to enroll in a supplemental program without underwriting.

Danny Brechin
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Norman Smith · Answer

What you've paid for all these years is your Part A, which is your hospital coverage. Part B is an underwritten part of Medicare. This is why Open Enrollment is so important, the first time it comes around, when there is no Underwriting involved.

Answered by Norman Smith on May 27, 2025

Agent Licensed in FL, AL, NJ & PA

Answered by Norman Smith Medicare Insurance Agent

Christopher Boyd · Answer

I am so sorry to hear about your situation. Unfortunately, the Joe Namath and countless other Medicare Advantage commercials,  brokers, and call centers usually neglect explaining a Medicare beneficiaries ONE TIME "Initial Enrollment Period" when they Turn 65 or drop a Medicare Advantage Plan with 12 months of enrollment back to Original Medicare to get a Medicare Supplement with No Health Questions. 

This is explicitly explained in your 2025 Medicare And You Handbook, but again, most brokers and call centers neglect walking someone through their Medicare And You Handbook when they Turn 65, or enroll into Medicare at an older age when leaving Group Health Insurance. 

You may be eligible for a very limited Special Enrollment Period in your area. Call 1 (800).Medicare and give them your zip code and plan details to see if you meet one of those very limited periods, such as moving to a different area, natural disaster, Medicare plan termination, etc. For example, if you move from State to State or from one area of your state to another where your current MAPD is not available, you are eligible for a short period of time for a MediGap Plan.

Pamela Masters · Answer

Medical plans are put out by private companies and even though they work with Medicare they are not put out by the government. They do have underwriting which can affect your ability to have the plan. Medicare Advantage plans do not have underwriting and cannot turn you down for health issues. They are also put out by private insurance companies.

Answered by Pamela Masters on October 10, 2025

Broker Licensed in NC

Answered by Pamela Masters Medicare Insurance Agent

John Becker · Answer

It's legal because Medicare Supplement (Medigap) plans are sold by private companies, and outside your initial 6-month Medicare Part B enrollment period, they can use medical underwriting (health questions) to deny coverage or charge more, even if you paid into Original Medicare, which is separate. However, federal law guarantees acceptance during that special enrollment window and certain Guaranteed Issue (GI) situations, but if you missed those, insurers can use your health history to decline you. 

What You Can Do
Check for GI Rights: See if you qualify for a Guaranteed Issue situation (e.g., moving out of a Medicare Advantage Plan) where you can't be denied.

Explore Other Options: Look into Medicare Advantage (Part C) plans, which have different enrollment rules, or see if your state offers extra protections.

Appeal the Decision: You can file an appeal with the insurer if you believe the denial was an error or if you have supporting information from your doctor.

Contact SHIPS: Your State Health Insurance Assistance Program (SHIP) offers free, unbiased advice to help you understand your options.

Lynn C Shurtleff · Answer

Medigap plans are private secondary insurance to your Medicare which cannot be denied. You received Medicare by working and paying into it but that has nothing to do with obtaining secondary insurance. Medigap plans are guaranteed issue when you first go on Medicare part B for a 6 month window but once that window closes there is underwriting unless you live in a Birthday rule state. There also may be certain circumstances that may be GI as well. In general, there is underwriting outside of your initial enrollment into Medicare and you can be denied.

Answered by Lynn C Shurtleff on November 14, 2025

Broker Licensed in TN, AR, CO & 6 other states

Answered by Lynn C Shurtleff Medicare Insurance Agent

Ronnie Robinson Jr · Answer

Your alternative option is a Medicare Advantage plan that you can't be denied from. How long has it been since this happened?

Nikki Rowland · Answer

Paying into Medicare makes you entitled to Part A and Part B. Medigap (Medicare Supplement Insurance) is offered by private insurance companies, not the government. And outside of certain protected times, they’re legally allowed to deny you coverage based.

Answered by Nikki Rowland on May 11, 2025

Broker Licensed in SC & NC

Answered by Nikki Rowland Medicare Insurance Agent

Lauren Fodde · Answer

It feels frustrating, but here’s why it happens: Medicare itself is guaranteed, but Medigap (supplement) plans are offered by private insurance companies. Outside of your one-time Medigap Open Enrollment window (the 6 months after you first get Part B), companies are allowed to use medical underwriting — meaning they can review your health history and deny coverage or charge more. The good news is there may be other options, like Medicare Advantage, that don’t use health questions, and I can help you explore the choices available.

Answered by Lauren Fodde on September 24, 2025

Broker Licensed in MO & FL

Answered by Lauren Fodde Medicare Insurance Agent

Michael Denniston · Answer

When you turn 65 or when you first enter Medicare you have guaranteed enrollment. That means you cannot be refused any Medicare Supplement plan during you first year eligible. After your first year you no longer have guaranteed enrollment. After your IEP (initial enrollment period) is over you can be underwritten and can be refused or rated up based on your health history and previous prescriptions taken. It is not against the law for a private insurance company to Denie your application when you are outside of guaranteed enrollment periods. This explanation does not cover every instance but the common. Michaels Insurance Solutions LLC, contact us.

Answered by Michael Denniston on July 12, 2025

Agent Licensed in FL, AL, AR & 11 other states

Answered by Michael Denniston Medicare Insurance Agent

Luke Rhoads · Answer

Medicare and Medicare supplement plans are separate entities. During your initial enrollment period when turning 65 you are guaranteed issue of the medigap policy. After that period you would be subject to underwriting where the insurer could choose to approve, deny, or adjust premiums dependent on underwriting.

Answered by Luke Rhoads on July 23, 2025

Broker Licensed in OK

Answered by Luke Rhoads Medicare Insurance Agent

Darlene Murphy · Answer

Paying for Medicare benefits, Part A, throughout your work life is not paying for Part B of Medicare and/or the secondary insurance coverage. An insurance company does not have to insure you outside of the timeframe when no medical questions can be asked.

Answered by Darlene Murphy on October 13, 2025

Broker Licensed in CA, AZ, ID & 7 other states

Answered by Darlene Murphy Medicare Insurance Agent

Mark Cunningham · Answer

Medigap plans, also known as Medicare Supplement Insurance, are private insurance policies designed to cover healthcare costs not included in Original Medicare. While Medicare itself is a federal program with standardized benefits, Medigap plans are offered by private insurers, and their rules can vary depending on state laws and circumstances. 

Medical Underwriting Outside Guaranteed Periods
If you apply for a Medigap plan outside your guaranteed issue period (when you turned 65), insurers are generally allowed to use a process called "medical underwriting." Medical underwriting enables them to evaluate your health history and decide whether to approve your application, decline coverage, or adjust premiums. This practice is permitted under federal law because Medigap plans are private insurance products, and insurers have the right to assess risk when determining eligibility outside federally protected periods.

State Regulations
While federal law sets the baseline for Medigap protections, states may have additional regulations that expand consumer rights. For example, some states prohibit medical underwriting entirely or allow open enrollment periods for Medigap plans beyond the federally mandated timeframe. If you were denied coverage, it may be worth investigating whether your state offers extended protections.

What You Can Do
If you have been denied a Medigap plan due to your health history, here are steps you can take:
•	Check whether you were within a guaranteed issue period at the time of your application. If so, you may be able to appeal the denial.
•	Consult your state’s Department of Insurance to learn about any state-specific rules that might apply.
•	Look for alternative forms of coverage, such as Medicare Advantage plans, which may provide similar benefits without medical underwriting.
•	Seek advice from a licensed Medicare counselor or broker who can help you navigate your options.

David Wiley · Answer

You have one opportunity only to apply for a MediGap plan with no underwriting( guaranteed issue) and that is when you are turning 65. After that it will be underwritten; however, you may always get a Medicare Advantage plan with guaranteed issue no matter your age or medical conditions. The Annual Election Period (AEP) is 10/15-12/07 every year and that coverage takes effect on 1/1 of the following year. Outside of AEP, you may get a Medicare Advantage Plan (MAPD) if you have a Special Election Period (SEP) with guaranteed issue. Your prescription coverage is also included in a MAPD plan and the premium can be as low as $0/month.

Answered by David Wiley on March 9, 2026

Broker Licensed in GA & NC

Answered by David Wiley Medicare Insurance Agent

Robert Simm · Answer

When we pay into Medicare what we're really paying into is part A coverage which is inpatient hospitalization. That includes nursing homes rehab centers hospice along with hospitalization. 
We have also paid into the Medicare system to reduce cost for Part B premiums along with out-of-pocket medical expenses like deductibles. When we first age into Medicare under the 12-month rule we have an option to move from Medicare Advantage to Medicare supplemental plan with original Medicare and a separate Part D prescription drug plan or you could just simply go with original Medicare Parts A and B along with a prescription drug plan. Within that 12 months everything is guaranteed acceptance. When you aged into Medicare the person should have explained the process on Medigap versus MAPD versus original Medicare. The insurance companies have a legal right to underwrite for risk and if they view a person as a high risk then they do have the right to deny the coverage. After the first year then Medigap underwriting will always continue until there's some government change for those plans.

Mark Zaruba · Answer

The Medicare plan you applied for is most likely a Medicare Supplement (Medigap) plan offered through a private insurance company. Medicare Supplement plans are regulated by the state in which they are sold, not by the federal government.

When you turn 65 and enroll in Medicare, you are granted a Medicare Supplement Open Enrollment Period by CMS (Centers for Medicare & Medicaid Services). During this time, private insurance companies must accept your application regardless of your health history. This enrollment window lasts for seven months: the three months before the month you turn 65, your birthday month, and the three months after your birthday month. The one exception is for individuals born on the first day of the month; in that case, the enrollment period begins one month earlier.

Applications submitted outside of this Medicare Supplement Open Enrollment Period may be subject to medical underwriting. This means the insurance company is legally allowed to review your health history and may deny coverage based on your medical conditions.

Kate Spilsbury · Answer

I completely understand how frustrating that feels—it doesn’t seem fair. The truth is, once you’re past your Medigap Open Enrollment Period, insurance companies can ask health questions and deny coverage based on medical history. It’s one of the few areas of Medicare that isn’t guaranteed. The good news is, we can look at Medicare Advantage plans or see if you qualify for a special enrollment or guaranteed issue option that would let you get coverage without health underwriting.

Answered by Kate Spilsbury on October 20, 2025

Broker Licensed in FL, AZ, CA & 7 other states

Answered by Kate Spilsbury Medicare Insurance Agent

Ryan George · Answer

When you first turn 65 (or are new to Medicare i.e. got off employer plan and retired past 65), you have what is known as your Initial Enrollment Period aka IEP. During this time you are able to get into any plan you should choose without worrying about pre-existing conditions. Once your personal IEP is over, you have to go through medical underwriting to change Medigap/Supplement plans.

Answered by Ryan George on February 3, 2026

Broker Licensed in PA, AK, AL & 49 other states

Answered by Ryan George Medicare Insurance Agent

Bubi Gorgevich · Answer

Hello,

I am Bubi Gorgevich, a senior agent working with Medicare beneficiaries for over 15 years, and your question got directed to me for assistance.
I am sorry that you got denied, but that is based on your medical history. The only time that Medicare Supplement is guaranteed without underwriting is during Initial Enrollment upon becoming eligible for Medicare.
There are some variations by providers, depending on your area.

If you want to discuss this matter further, please feel free to contact me.

Best Regards

Chad Sickle, RN · Answer

If you were new to Medicare, you should not have had to answer any health questions. If not, a Medicare Advantage plan might be your best option, no health questions and includes dental, vision, hearing and drugs along with many other perks like gym memberships and money for OTC items.

Answered by Chad Sickle, RN on January 12, 2026

Broker Licensed in NC & SC

Answered by Chad Sickle, RN Medicare Insurance Agent

Lauryn Ivey · Answer

A Medigap plan is a secondary insurance plan. It is not regulated by Medicare, in Alabama it’s regulated by the Alabama Department of Insurance. Medigap Plans are issued by independent insurance companies they only cover where Medicare stops; like the 20% you would be responsible to pay after Medicare pays their 80% on Part B charges. It has nothing to do with paying into Medicare for years, because the Medigap Plan is not Medicare. The Medigap Plan is an independent company that sets its own rules, regulations, and policies; so, the only guaranteed issue periods are when you first become eligible for Medicare, or once you retire and pick up Part B if you worked past 65 years of age. So, if you are not in a guaranteed issue period, the Medigap Plan application goes through underwriting and there are health questions. If you have one of the companies disqualifying health conditions or medications they can and will deny the application. You would want to work with a licensed agent because each Medigap Plan has different underwriting guidelines, so an agent could help you find one that you would qualify for.

Answered by Lauryn Ivey on July 11, 2025

Broker Licensed in AL

Answered by Lauryn Ivey Medicare Insurance Agent

Mark Sannes · Answer

Supplement Open Enrollment is within 6 months after your Part B Effective Date. There are No Health Questions, and you are guaranteed issue. 

Medical Underwriting - If you do not sign up during the above times, you may have to answer health questions to qualify. They can deny you based on their risk factors.

Alyssa Burgos · Answer

Medigap plans require you to get on a plan right when you get A and B or when you turn 65. They will underwrite you when you were on a Medicare Advantage plan previously.

Paul Granen · Answer

A Medicare Supplement, or Medigap, is a supplement to Original Medicare offered by private insurance companies. Your Medicare (Red, White & Blue card) is what you paid into. MedSupps are underwritten, very similar to life insurance. Being denied by one carrier does not mean that another company will not accept you. Each company has their own underwriting criteria.

Answered by Paul Granen on May 11, 2026

Broker Licensed in LA, AL, AR & 28 other states

Answered by Paul Granen Medicare Insurance Agent

Alma Preciado · Answer

Medigap plans also known as Supplement Plans have to go through underwriting unless you fall under certain criteria's that guarantee issue . For example, if your plan is canceling out of your county or loss of employer coverage

Answered by Alma Preciado on January 5, 2026

Agent Licensed in CA

Answered by Alma Preciado Medicare Insurance Agent

William Lux · Answer

Medicare is the government healthcare system that is paid for, in part, through payroll taxes, and there is no underwriting (health questions)to become eligible. In other words, you can’t be declined coverage due to pre-existing conditions. 
However, outside of a guaranteed issue period, like when you first become eligible and enroll in Medicare, medigap plans offered by insurance companies require underwriting health questions to determine eligibility, and the applicant can be denied coverage due to certain health conditions.

Steven Bleicher · Answer

When you turned age 65, you had a true open enrollment (you are called a "GUARANTEED ISSUE person) since no medical questions will be asked of you. Plus, all pre-existing conditions are fully eliminated from disclosure. 

Thus, you chose a free Medicare Advantage plan as the alternative. That plan has always been totally free of monthly premiums because it is subsidized by the Federal government. However, the "give & take" with those plans is that every one of them will contain a fairly steep deductible each year. If you have had multiple hospitalizations, the # of days spent in a semi-private room will be applied toward that deductible. It will be charged based upon the discretionary rules of the firm's policy that you have joined. These daily hospital rates vary from firm to firm. Should you go over that threshold (for example, $2,900.00/year) including other Part B medical treatments, that is your Maximum Out-of-Pocket expense (or MOOP). Subsequently every brand new year, that amount begins all over again, potentially at a higher price based on our global economy.

Andrew Zurbuch, MBA · Answer

For Medigap Insurance it depends on where you live. Your State of residence determines what guaranteed issue rights they have. You can apply through another Insurance Company. If you don't qualify for a Preferred rate, then it is possible you can qualify for a Standard rate. Underwriting can vary between Insurance Companies. Please contact a Broker.

Answered by Andrew Zurbuch, MBA on September 16, 2025

Broker Licensed in IN, FL, KY, MO, OH & TN

Answered by Andrew Zurbuch, MBA Medicare Insurance Agent

Jim Tretola · Answer

If you do not have Guaranteed Acceptance, that is, unfortunately, the rule. Certain States(like New York), are different and do not require Medical Underwriting. Insurance Companies do not want to lose money and there is a push toward managed care, which has many people going into Medicare Advantage Plans.

Answered by Jim Tretola on October 5, 2025

Broker Licensed in NJ, CA, CT & 6 other states

Answered by Jim Tretola Medicare Insurance Agent

Timothy Brown · Answer

Your acceptance into a Medicare supplement/Medigap plan is guaranteed during the 6 month period of when Medicare Part B becomes effective. You're subject to underwriting beyond this timeframe unless you're leaving an employer plan. Unlike Medicare Advantage plans which are guaranteed issue with no health questions, Medigap plans are not regulated by CMS (Centers for Medicare & Medicaid Services). They are private companies.

Answered by Timothy Brown on April 8, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Walt Smith · Answer

In New Jersey at least Maida got plans are only guaranteed issue when you first apply for them and your first eligible. After that, they are medically underwritten.  Always been that way.

You can get a medical advantage plan during open enrollment with no underwriting

DeeDee Whitlock · Answer

You are NOT being denied Medicare, that is available to you at 65 or if on disability at younger age. Medigap is an EXTRA plan that covers out of pocket that Medicare don't and therefore you are subject to underwriting!!

Answered by DeeDee Whitlock on June 10, 2025

Broker Licensed in LA

Answered by DeeDee Whitlock Medicare Insurance Agent

Vernon Jones · Answer

It is legal because apparently you were beyond your Open Enrollment period which is a 6 month window that begins the first month you have Medicare Part B. During that time you can enroll in any Medigap plan and you will be accepted for there is no health question. But if you were to try to get a Medigap beyond that age and time you will have to pass the health question and if not you will be declined by the insurance carrier.

Answered by Vernon Jones on August 14, 2025

Broker Licensed in NC & SC

Answered by Vernon Jones Medicare Insurance Agent

Kris Moen · Answer

Unfortunately, it is legal in most states — including North Dakota — for Medigap companies to deny applications based on health unless you’re in a protected enrollment window.

This feels frustrating because people have paid into Medicare for decades, but Medigap insurance is private insurance, not part of Medicare itself.

Anna Davis CIC-RSSA · Answer

Here’s the sad truth:
Medicare only guarantees your Medicare Supplement (Medigap) enrollment during the first six months after you enroll in Part B—or in a few other very limited situations.
On day 181, your application is subject to medical underwriting, and the insurance company is not required to accept you. If you're denied, your only option may be a Medicare Advantage plan available in your area.
Either way, you should get some form of coverage—because relying on Original Medicare alone exposes you to unlimited financial risk, especially in the case of major surgery, cancer treatment, or emergency transport.
Trust me—you do not want to be stuck paying 20% of a helicopter ride out of pocket.

Lea Vollmer · Answer

The only time you have a guaranteed issue is when you first enroll in the Medicare program. A thorough needs assessment should have brought to your attention that a supplement would have been good for you in the beginning due to your health history

Answered by Lea Vollmer on October 30, 2025

Broker Licensed in IL, AL, AZ & 7 other states

Answered by Lea Vollmer Medicare Insurance Agent

Celeste McGrath · Answer

The taxes you've paid into Medicare for years enables you to get Part A with no monthly premium. That is all. A Medigap plan is through a private insurance company and completely separate from the Federal Medicare program so that company has the ability to deny based on medical history. It's not a perfect system but working with a Licensed Medicare Specialist can help you go through all of your options to find the best plan option for you and your situation.

Answered by Celeste McGrath on March 23, 2026

Broker Licensed in GA, FL, NC & SC

Answered by Celeste McGrath Medicare Insurance Agent

Lou Spatafore · Answer

Medicare will accept you as that is what you qualified for from your employment contributions. A Medigap plan is provided by private insurance companies and with some exceptions there is medical underwriting to determine eligibility except during the initial election period when you have guaranteed issue rights.

Answered by Lou Spatafore on March 2, 2026

Broker Licensed in WV, FL, GA & 10 other states

Answered by Lou Spatafore Medicare Insurance Agent

Françoise Mueller · Answer

You only get “guaranteed acceptance” during certain periods
These include:

Your Initial Enrollment Period at 65

Losing employer coverage

Your Medicare Advantage plan leaving the area

Certain trial rights

If you apply outside these windows, underwriting kicks in.

Medigap companies are private insurers
They’re not required to accept everyone year‑round.
Outside your guaranteed issue window, they can:

deny you

charge more

impose waiting periods

This is written into federal law.

Medicare Advantage plans cannot deny you
This is why so many people end up choosing Medicare Advantage after being denied a Medigap plan.
Advantage plans:

don’t use underwriting

accept all health conditions (except ESRD in some states)

cap your yearly out‑of‑pocket costs

often include dental, vision, hearing, and drug coverage

For many people, it becomes the only realistic option.

Harold Randolph · Answer

I can definitely understand your frustration. Without any additional information I’d have to assume that you have Medicare parts A and B to apply for the medigap. 

A medigap is an insurance product designed to pick up the out of pocket expenses that Medicare leaves behind with copays deductible and coinsurance. It is not a government part. It is sold by private insurance. 

For your work years and contributions you are entitled to Part A and eligible for Part B.

Rukshini Sandrasegaran · Answer

Medigap is run by private insurance companies.  Federal laws allow these companies to assess health risks outside of the specific protected period.

Christopher Orr · Answer

You only have a open /guarantee option when you first come on medicare or if later when coming off group coverage...

Joseph Ford · Answer

Even though you have paid into Medicare over the years, in most cases, you would have to qualify by medical history, but there might be another option for you, if you would like to discuss, contact me.

Answered by Joseph Ford on December 26, 2025

Agent Licensed in CA

Answered by Joseph Ford Medicare Insurance Agent

Bruce Kaserman · Answer

Yes it is because Medicare Supplements or Medigap is underwritten after the initial 6 month period when the beneficiary turns 65. Just curious, have you looked at other supplements where the premium may be higher because of underwriting>

Answered by Bruce Kaserman on December 29, 2025

Broker Licensed in VA, FL, MD & NC, NJ, NY & PA

Answered by Bruce Kaserman Medicare Insurance Agent

Tracy Corwin · Answer

It's because you are applying for a private insurance not Medicare. You ARE entitled to Medicare. You can sign up for a Medicare Advantage plan and won't get denied as they take the place of Medicare so essentially they become your Medicare. Most Advantage plans are free or have a low premium. Many also have no Deductible. Please reach out if you would like help selecting one. Tracy Corwin

Answered by Tracy Corwin on April 27, 2026

Agent Licensed in OR

Answered by Tracy Corwin Medicare Insurance Agent

Fred Manas · Answer

While it's frustrating to be denied a Medigap plan due to health history, it's legal for insurance companies to use medical underwriting to assess risk. This means they can decline coverage or impose restrictions based on your health, especially outside of the guaranteed issue period or other specific situations.

However, you do have rights during your open enrollment period and under specific guaranteed issue rights. 

Here's a more detailed explanation:

Medical Underwriting:
Medigap insurers use medical underwriting to assess risk. This involves reviewing your medical history to determine the likelihood of future claims and potential costs. 
Guaranteed Issue Rights:
During your Medigap open enrollment period (six months after enrolling in Medicare Part B), you have guaranteed issue rights, meaning you cannot be denied coverage based on health. You also have guaranteed issue rights in other specific situations, such as if you lose coverage from a previous health plan and enroll in Medicare within 63 days. 
Denial and Pre-existing Conditions:
Outside of guaranteed issue periods, Medigap insurers can deny coverage or impose restrictions (like waiting periods) for pre-existing conditions. 
State Variations:
Some states offer more extensive guaranteed issue protections than federal law, according to United American Insurance Company.
Appealing a Denial:
If you're denied coverage, you may have the right to appeal the decision. You can gather information from your provider, explain your situation, and potentially provide additional medical records according to The National Council on Aging. 
In summary: While it's understandable to feel frustrated about a denial, it's important to understand that Medigap insurers can deny coverage based on health history, particularly outside of guaranteed issue periods. However, you have rights during open enrollment and under other specific situations, and you may also have the right to appeal a denial.

Gary Henderson · Answer

There are several reasons. First of all, if you first sign up for Medicare parts a and then b. Even if b is later, you have a 6-month period where you cannot be denied coverage. 
After that, most insurance companies can deny you coverage when you're first signing up for Medicare plan. 
If you already have a Medicare plan and want to change it, there are a few states that have special consumer Medicare laws that allow you to change them, for example, for a period around your birthday 
People often think that with the ACA plans often called Obamacare that you couldn't be denied coverage that does not apply to Medicare. It applies to insurance in the ACA plans for people 65 and under only

Andrew Kramer · Answer

The fact that you paid into Medicare for years has nothing to do with a supplement turning you down for health issues. But it sounds like you waited past your guarantee issue to apply for a supplement. Guaranteed issue is either when you turn 65 and for 5 more months, or when you drop employer group health coverage and sign up for Part B. There are a few other guarantee issue periods outside of that, like having an Advantage plan and moving from their service area. But if you did not qualify under those conditions, you are subject to health underwriting in most states. Moral of the story - do your homework before it's too late.

Answered by Andrew Kramer on August 1, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Meghan Blankenship · Answer

That's a frustrating experience - and your reaction is completely understandable. You've paid into Medicare for decades, so being denied coverage for a Medigap plan can feel unfair. But here's what's going on legally and practically: Medigap(Medicare supplement) plans are sold by private insurance companies, not the federal government. While Original Medicare must accept everyone, Medigap insurers can use medical underwriting - meaning they can deny coverage or charge more based on your health - unless you're in a protected enrollment window.

Answered by Meghan Blankenship on November 16, 2025

Broker Licensed in FL, MD & OH

Answered by Meghan Blankenship Medicare Insurance Agent

Marcie Barnes · Answer

Medigap policies are private insurance companies that coordinate with original Medicare.  They're not subject to CMS regulations.

There are ways around having to go through underwriting such as:

You are new to Medicare 
You lost credible coverage 
Some states have a birthday or anniversary rule.  Caveat is you must already be enrolled in a Medigap plan and wanting to switch to another one.

Suzanne Lamperti · Answer

Unless it's your initial Part B sign up, insurance companies can deny you for coverage. Some health issues put you at a high risk level.

Jack Mayer · Answer

You can only get a Medicare Supplement without answering specific health questions only when you are turning 65 and enrolling for the first time. You have 3 months before your birthday month, your birthday month and 3 months after. Its a bit different when coming off a Group Employee Health plan.

Answered by Jack Mayer on January 5, 2026

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Deborah Webster · Answer

Medigap plans are a supplement to Medicare A and B ( Original Medicare). Medical plans do have health underwriting. The only time you do not have to pass underwriting is when you are first eligible for B outside of that you must be able to pass underwriting. Medigap companies do not all have the same health questions. It's important to work with an agent who has multiple options to look at underwriting and find a carrier who may take your current pre-existing conditions.

Answered by Deborah Webster on May 8, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Rodolfo Rojas · Answer

For Medicare Supplement, you can only access it without denial during the first 6 months of your eligibility for Medicare. After you would go through medical underwriting. They can deny you.

Antonio Rodriguez · Answer

Response:
I totally understand why that feels unfair. The important thing to know is that Medigap plans are run by private insurance companies, not Medicare itself. Even though you’ve paid into Medicare for years, those private companies are allowed to ask health questions and can deny applications based on medical history in most situations.

The good news is that there are certain times — called Guaranteed Issue periods — where companies must accept you with no health questions. These happen in specific situations, like losing certain types of coverage or moving. If you think you might qualify for one of those protections, I can help check that for you and explain your options.

Just let me know your situation and I can walk you through the rules so you know exactly what you can still qualify for.

Adam Ernst · Answer

That is a good question. If you are turning 65 and are in your initial enrollment period, you qualify for a Medicare supplement no matter what. If you are coming off of work coverage, you should qualify as well. If you are past that period, you now have to go through underwriting, just like with a life insurance policy. You still have Parts A and B no matter what. Are you past 65? You can qualify for a Medicare Advantage plan or private Medicare that is handled by the private carriers.

Answered by Adam Ernst on November 8, 2025

Agent Licensed in NC, SC & TN

Answered by Adam Ernst Medicare Insurance Agent

Charles Borg · Answer

A Medigap plan is issued by a private insurance company, not the government. You paid into government coverage, Medicare where you can’t be denied. You had a grace period when you-turned 65 for 6 months to get a Medigap policy, regardless of your health, but you didn’t take advantage of it.

Answered by Charles Borg on May 27, 2025

Agent Licensed in FL & NY

Answered by Charles Borg Medicare Insurance Agent

Linda Davies · Answer

If you are within your Medigap Open Enrollment Period or qualify for guaranteed issue rights, it is illegal for an insurance company to deny you a Medigap policy solely based on your health history. 

However, if you apply outside of these protected periods, insurance companies are generally allowed to consider your health history during the underwriting process and could deny your application or charge you higher premiums. 

It's highly recommended to apply for a Medigap policy during your Open Enrollment Period or if you have guaranteed issue rights to ensure guaranteed acceptance and potentially lower premiums.

David Christian · Answer

Medigap plans have Underwriting that determines your qualification for the plans and as you see your health history can make it so you get denied. My suggestion for you is a Medicare Advantage Plan because there is no underwriting for anyone of any age that has Medicare or to get a Medigap plan when a company waives the underwriting during a certain period of time.

Answered by David Christian on April 11, 2025

Broker Licensed in CA & TX

Answered by David Christian Medicare Insurance Agent

Adam Morillo · Answer

This is a great question, and it’s a concern many seniors share. While it's true you've paid into Medicare through your taxes, Medigap (Medicare Supplement) plans are actually offered by private insurance companies, not the government. That means they can set their own underwriting rules outside of certain protected time periods. So while it feels unfair, it's legal under current rules. However, there may still be other options available depending on your situation and the state you live in.

Answered by Adam Morillo on August 7, 2025

Broker Licensed in FL, AK, AL & 48 other states

Answered by Adam Morillo Medicare Insurance Agent

Amy Jones · Answer

Medigap plans are offered through private insurance companies, usually charge monthly premiums, are not funded by the government, and therefore, are not affected by you paying into Medicare via tax withholdings. Under federal law, you have an open enrollment period that begins the month you turn 65 and/or enroll in Medicare Part B, and that enrollment period lasts for 6 months. During that 6 month window, you have “guaranteed insurability”, which means insurance companies cannot deny you due to pre-existing health conditions. Outside of that time frame, there are only select cases when you are considered to have guaranteed insurability, and those would typically be due to involuntary loss of coverage through another insurance plan, such as employer sponsored healthcare, or having Medicare Advantage and moving to an area where no Advantage plans are available.

Answered by Amy Jones on April 6, 2026

Broker Licensed in WV, AL, AZ & 29 other states

Answered by Amy Jones Medicare Insurance Agent

Jeremy Watson · Answer

Yes, companies have the ability to decline Medigap applications based on health and/or medications outside of any guaranteed approval period. Medigap plans are optional coverage, so underwriting is within the companies rights. With that being said, companies also have different underwriting criteria. You may be able to be covered by a different company. Some are more strict while some are more laxed.

Answered by Jeremy Watson on October 10, 2025

Broker Licensed in IN, FL, KY & MI, OH, SC & TN

Answered by Jeremy Watson Medicare Insurance Agent

Larry Pereiro · Answer

Medicare policies are not Medicare plans. They are "supplemental plans", providing benefits to off set the cost of Original Medicare Plan A and B, and if you are outside of the Open Enrollment period when you turn 65, they are medically underwritten. You must have Medicare Part A and Part B in order to enroll in a Medigap, but that is not guaranteed issue status outside of the open enrollment period.

Answered by Larry Pereiro on June 2, 2025

Agent Licensed in IN

Answered by Larry Pereiro Medicare Insurance Agent

Shahwali Hotaki · Answer

Yes, it’s legal. Medicare is guaranteed once you’re eligible, but Medigap is private insurance with its own rules. Outside your one-time Medigap Open Enrollment Period (the 6 months after you first get Part B), insurers can use health history to deny or charge more.

Answered by Shahwali Hotaki on August 21, 2025

Agent Licensed in CA, CO, GA, IL & VA

Answered by Shahwali Hotaki Medicare Insurance Agent

Ingrid Kollmann · Answer

It's because you don't live in California which has a birthday rule.  A few other states may have a similar rule, depending on the available plans.

Tony Hardwick · Answer

It's because those plans are sold by private insurers that use underwriting. Only during the Medigap open enrollment period or "guaranteed issue" can a company be forced to accept an application without health questions.

Answered by Tony Hardwick on March 18, 2026

Broker Licensed in GA, AL, AR & 32 other states

Answered by Tony Hardwick Medicare Insurance Agent

Albert Smith · Answer

Well, the question today is I applied for a Medigap plan and got denied because of my health history. How is that legal when you've paid into Medicare for years? A Medigap plan, first you need to know the difference between Medicare and a Medigap plan. If you're not in your open enrollment period, when you have to accept you or a special guaranteed issue time frame, then you are subject to what they call underwriting. Underwriting, they take it for a Medigap, which is a supplement plan. It's a supplement to Medicare. It is not Medicare. It just pays what Medicare does not pay. So if your health doesn't fit the particular company, you can find other companies that might fit, but a particular company does not have to accept you. If you have certain health conditions, it kind of raises their costs. But what you have, you have an option. You have an option. You can go with what's considered a Medicare Advantage plan. And that Medicare Advantage plan will cover most things that relate to your health history, regardless of what it is, given certain times of the year. So those are your options. Medigap is a supplement, and the supplement has pre-existing conditions. If you're not within your guaranteed time frame, you're not able to get it. But we're here to help you, we'll help you along the road to find out.

Jason Marshall · Answer

Medigap plans are not governed by the CMS which means they can adhere to their underwriting guidelines. They do have some non underwriting periods and rules that will allow you access. Partnering with the right agent will help you know when the right time to apply comes about.

Answered by Jason Marshall on November 16, 2025

Agent Licensed in CA

Answered by Jason Marshall Medicare Insurance Agent

Matthew Moreno · Answer

So medigaps are regulated by the state level and not by medicare or medicaid services. So that means that the insurance company's assuming there is no guaranteed issue reason such as a life event are allowed to do underwriting and deny you for medigap coverage by them. A good idea is sometimes to ask the agent is there any guaranteed issue medigaps in my area? In some cases there are and in others there is not.

Answered by Matthew Moreno on September 10, 2025

Broker Licensed in IL, AZ, FL, TX & VA

Answered by Matthew Moreno Medicare Insurance Agent

Danielle Jimison · Answer

You did pay into Medicare for years, but you paid into Medicare Part A and Part B, not Medigap. Medigap is sold by private insurers, and approval is not guaranteed outside Enrollment Periods. Insurers can deny your application based on health conditions or charge more. Medical underwriting applies any time you apply outside your protected window, and health conditions can lead to denial.

Answered by Danielle Jimison on December 22, 2025

Broker Licensed in OH & PA

Answered by Danielle Jimison Medicare Insurance Agent

Diana Muhammad · Answer

Medicare and Medigap Plans are not one and the same. Medicare is offered by the federal government. Medigap Plans are Supplemental Plans offered by private insurance companies that have contracted and been approved by Medicare to provide services. Insurance companies provide services based on risks. Medigap Plans participants go through an underwriting process.

Answered by Diana Muhammad on October 19, 2025

Agent Licensed in IL, CA, FL & 8 other states

Answered by Diana Muhammad Medicare Insurance Agent

Tanisha Coffey · Answer

The payments you paid into Medicare during your working years covers services related to Medicare Part A and the premium you currently pay for part B covers that. If you were applying for Medigap, that means you opted for Original Medicare. Original Medicare requires you pay 20% of costs. Medigap is not part of Medicare. It is a supplement that one can obtain if they want to lessen the potential out of pocket costs related to the 20% Medicare doesn't cover. So, they are not one in the same. Medigap is a supplement provided by a 3rd party insurance company to cover part of that 20% that would be your responsibility. As such, as with most health insurance (primarily excluding employer-provided plans, ACA & Medicare) and health insurance supplements or indemnity plans, acceptance to cover an individual is at the carrier's discretion. The only time Medigap plans typically are not underwritten (medical conditions not considered) / at the carrier's discretion is when you first start Medicare.

Daniel Matar · Answer

Medigap policies are issued by private insurance companies, and therefore have underwriting requirements in some cases.

Debbi Wallace · Answer

The only time you can get a supplement(medigap) plan with no denial is when you first turn 65. Otherwise it goes thru underwriting and they can deny you based on medical history.

Paul Mercier · Answer

A medigap plan is not a Medicare plan. You get the Medigap plan from a private insurance company i.e. humana, united health, etc. Some states do not have guaranteed issue in which case you can look into a Medicare Advantage plan

Scott Klag · Answer

Medicare Supplements are different than your Part C Medicare Advantage plans. Medicare supplements have a "Guarantee Issue" time period which is 3 months prior to your 65th Birthday, the month of your 65th Birthday and 3 months following your 65th Birthday. There are a few other situations that would offer the "Guarantee Issue" option. You would need to consult with your Medicare professional agent to see if you qualify. Otherwise, in order to get a Medigap plan you would be subject to medical approval.

Tanja Roulhac · Answer

I understand your frustration—it's disappointing to be denied coverage after contributing to Medicare for years. Let me explain why this can happen and what your options might be. Medigap plans are offered by private insurance companies, not the government, so their rules differ from Medicare itself. Here's a clear breakdown:

Why Denials Based on Health History Are Legal
Medigap vs. Medicare: Original Medicare (Parts A and B) is guaranteed and doesn't consider your health history, but Medigap policies are supplemental insurance sold by private insurers. Under federal law (as outlined by CMS), these companies can deny coverage or charge higher premiums based on health factors outside of specific enrollment periods. This is allowed because Medigap is not part of the core Medicare program you paid into.

Open Enrollment Period: During your 6-month initial window (starting the month you turn 65 and enroll in Part B), insurers cannot deny you a Medigap plan or use your health against you—it's a guaranteed issue period. If you applied outside of this, denials are possible and legal, as states regulate but don't always prohibit underwriting.

Legality: This practice complies with the Affordable Care Act and state insurance laws, which balance consumer protections with insurer risks. It's not ideal, but it's how the system is structured to keep premiums affordable for everyone.

What You Can Do Next
Check for Guaranteed Issue Rights: If you qualify (e.g., due to losing other coverage, moving states, or your plan being canceled), you might still get a Medigap plan without health questions. Review your situation on Medicare.gov.

Explore Alternatives: Consider Medicare Advantage plans (Part C), which often include additional benefits like vision or dental and might not require health underwriting during enrollment periods. You could also look into state high-risk pools or other supplemental options.

Appeal or Shop Around: Contact the insurer for an appeal or reasons for den

Michael Hixson · Answer

A "Medigap" or Medicare Supplement Plan is offered by insurance companies. They are not offered by the Centers of Medicare Medicaid Services. In other words, these are Private Plans that pay the Co-Pays that Original Medicare doesn't cover. The time to buy these types of plans is during your Open Enrollment Period. During this period there are no health questions. This period is up to 6 months be for your 65th birthday and up to 6 months after your 65th birthday or up to  6 months after your Part B effective date. If you missed these opportunities, there are some ways you may qualify for Guaranteed Enrollment with loss of credible insurance or in some states a birthday rule.

Roseann Vandevender · Answer

Medi Gap Insurance is not Medicare. You must have Medicare Part A &B in order to apply for Medi Gap Supplemental policies. These policies give you extra coverage the fill in the gaps in coverage that Original Medicare can leave open for you. Everyone has a "freebie in" when they first apply for their Part B Coverage. You will not be asked medical questions at this time everyone who applies will not "have a preexisting condition." You can always switch your plans between Advantage Plans (Part C) and Medi Gap during AEP. But after your intial year of Medicare you must health Qualify with the private insurers that provide the Medi Gap policy coverage.

Alisa Mathis · Answer

Medigap plans are not Medicare, and they are not health insurance. They are supplemental plans that help cover your out-of-pocket costs associated with Medicare insurance.

Irma Lopez · Answer

Underwriting is required if you don’t enroll during the Open Enrollment which is 3 months before you turn 65 or by no later than 3 months after your birthday.

Tammy Monjaras · Answer

The Medigap plan you applied for is held by a private insurance company and is not part of Medicare. Medicare covers 80 percent of your medical expenses. The medigap plans would cover the remaining 20 percent. As a private insurance company they have the right of refusal due to your health history if you are not eligible for a guarantees coverage period. Normally the guaranteed coverage period is when you initially sign up for Part B or a few other special enrollment periods.

Darko Bozic · Answer

Medigap plans are private plans and they are only guaranteed if you sign up for one within 6 months of being on Medicare. After that you can be denied based on your health history. These plans have nothing to do with what you've paid into Medicare. The original Medicare parts A and B cover that. Medigap plans are designed to cover some or all things that the original Medicare does not

Sherri Beach · Answer

I hear this concern a lot, and it can definitely feel frustrating and confusing.

The key thing to understand is that Original Medicare (Part A and Part B) is guaranteed coverage based on your work history and taxes paid — and you cannot be denied that coverage due to health history. However, Medigap (also called Medicare Supplement insurance) is a separate private insurance policy, and that’s where underwriting rules can come into play.

In most states, Medigap plans are only guaranteed issue during specific enrollment windows, such as your initial Medigap Open Enrollment Period (which starts when you’re 65 or older and enrolled in Part B). Outside of that window, insurance companies in many states can review your health history and may approve, deny, or charge higher premiums based on medical underwriting.

There are exceptions. Some situations create guaranteed issue rights — such as losing employer coverage, moving out of a plan’s service area, or certain plan changes — which can give you another chance to get Medigap coverage without health questions.

So while it may feel unfair compared to Medicare itself, Medigap is regulated differently because it’s optional private insurance, not federal coverage.

If you’ve been denied, it’s worth reviewing whether you qualify for a guaranteed issue period or exploring alternative coverage options like Medicare Advantage. A licensed Medicare agent can walk you through those options and help you understand what you’re eligible for right now.

Dan Griggs · Answer

Did you apply within the allotted time after coming off a group insurance plan? If so it is Guaranteed Enrollment. If not then you have to go through medical questions for underwriting. Always best to check with a qualified Medicare broker before you turn 65 and before you leave a group plan.

Christie Bondos · Answer

Some states have a Guaranteed Issue for Pre-existing Conditions while others do not. You should  consult with an Agent who is versed on these particulars in your state.

Jerry Wilson · Answer

When an individual enrolls into Medicare this is known as the Initial Enrollment Period.  With the Initial Enrollment Period (IEP) the Medicare Beneficiary will have a guaranteed right to enroll into Original Medicare, Medicare Supplement or Medicare Advantage Plan with any health underwriting or questions.  

However, once the guaranteed period has expired and Medicare beneficiary applies for a Medicare Supplement the private health insurer which issues the Medigap/supplement can deny coverage if the Medicare beneficiary is unable to pass the health underwriting questions.

Jake Dalton · Answer

Medi-gap plans (otherwise known as Medicare Supplements) are not governed by Medicare. They are underwritten by insurance companies. The risk has to be acceptable for the insurance company to assume the liability. Has nothing to do with Medicare, or what you've paid into the system. 
Whereas Part C or Medicare Advantage plans are highly governed by CMS (Center for Medicare Services) and do NOT ask any health questions.

Barb Koch · Answer

It might depend on the timing of when you are trying to apply for Medigap.  There is a timeline when you can apply without getting denied.  Contact a trusted Broker to go over what you need and what is available.

Kerry Fletcher · Answer

It's legal because Medicare Supplement (Medigap) plans are sold by private companies that can use medical underwriting (health questions) to deny coverage or charge more unless you're in a special "Guaranteed Issue" period, like your initial one when first getting Medicare Part B. 

Even though you paid into (Original Medicare), Medigap is a separate, optional policy that supplements it, and federal law allows underwriting outside of specific guaranteed times, though some states offer extra protections.

Bridget Shanks · Answer

Traditional Medigap plans allow members to enroll in any Medigap plan available in your county without answering any health questions only when you are within 6 months of initial medicare part B start date. Outside of that initial window- underwriting rules apply with a few guaranteed issue exceptions. Carriers can determine whether or not they will accept you & the rates you will pay based on your health. 
Medicare advantage plans on the other hand -do not require any health questions- so that’s always an option for you during the annual enrollment period. You might also be eligible for a special election period during the year.
Please visit our HEB waxahachie medicare help desk Tues-Thurs 9a-1pm - we are happy to assist you in any way we can!