If you’re approaching Medicare eligibility or looking to switch Medigap policies, you might be wondering if you could be denied a Medigap plan in 2025. The answer is yes, under certain conditions. Understanding when and why denial happens is key to protecting your health coverage and avoiding costly surprises.
At Skyline Benefit, we help seniors compare Medigap plans, understand their rights, and apply during the right enrollment windows to avoid denials.
This blog breaks down the situations where you can be denied Medigap coverage in 2025 and the smart steps you can take to avoid it.
What Is a Medigap Plan and Why Might You Need One?
Medigap (Medicare Supplement Insurance) helps cover out-of-pocket costs left behind by Original Medicare, like copayments, coinsurance, and deductibles. Plans are standardized (A–N), and they give you the freedom to see any provider that accepts Medicare nationwide.
Unlike Medicare Advantage, Medigap plans don’t include Part D prescription drug coverage, but they provide predictable costs and flexibility.
When Can You Be Denied a Medigap Plan in 2025?
Most people are surprised to learn that you can be denied a Medigap plan in 2025 if you apply outside certain protected periods. Here are the top scenarios:
1. You Apply Outside Your Medigap Open Enrollment Period
- This 6-month window begins the month you turn 65 and enroll in Medicare Part B.
- During this time, insurance companies cannot deny you or charge more due to pre-existing conditions.
- Once this window closes, insurers may require medical underwriting.
2. You Try to Switch Plans Later Without Guaranteed Issue Rights
- After your Open Enrollment Period, carriers can ask health questions.
- If you have certain chronic conditions, they can legally deny your application.
- Some plans may also charge higher premiums based on age or health.
3. You Miss a Guaranteed Issue Right
- These are special protections when you lose other coverage (e.g., Medicare Advantage plan ends, employer plan ends).
- You have a 63-day window to apply for Medigap plans without medical underwriting.
- Outside that window? You can be denied.
Which Pre-Existing Conditions May Lead to a Denial?
While each insurer uses different underwriting guidelines, these are common conditions that could lead to rejection:
- Heart disease or congestive heart failure
- Diabetes with complications
- COPD or severe asthma
- Cancer within the past 2 years
- Kidney disease or dialysis
- Recent hospitalizations
If you’re worried about these, timing your application is critical.
How to Avoid Being Denied a Medigap Plan in 2025
1. Apply During Your Medigap Open Enrollment Period
This is your best chance to get any plan with no health questions asked. Mark your calendar for the 6-month window starting when you enroll in Part B.
2. Use Your Guaranteed Issue Rights Wisely
If you lose coverage, retire, or move, you may qualify for guaranteed issue rights. Act fast—these windows usually last 63 days.
3. Work with a Trusted Medicare Broker
At Skyline Benefit, we understand each insurance company’s underwriting rules. We’ll help you time your enrollment, choose the right plan, and avoid denial—even if you’ve missed your initial window.
What If You’ve Already Been Denied a Medigap Plan?
If you’ve been denied Medigap coverage:
- You can still enroll in a Medicare Advantage plan, which can’t deny you based on health.
- You may wait for the next guaranteed issue opportunity or switch carriers if the underwriting rules differ.
- Contact Skyline Benefit to explore state-specific protections or high-risk Medigap pools if available.
Can States Offer Additional Protections?
Yes. Some states like New York and Connecticut offer continuous guaranteed issue. Others have birthday or anniversary rules that allow switching without underwriting.
Unfortunately, California currently limits guaranteed issue rights, so working with a broker is crucial.
Need Help Avoiding a Denied Medigap Plan in 2025?
Skyline Benefit is a licensed Medicare agency that helps Californians compare Medigap plans, navigate enrollment timing, and avoid costly mistakes. Whether you’re turning 65 or trying to switch, we’ll walk you through every step.
Schedule a consultation today. Call us at: (714) 888-5112