A Medigap insurer may be allowed to decline an application outside protected enrollment situations. That is different from denying a particular medical bill after a policy is active. Start by identifying which decision you received.
Three different decisions
| Decision | What to examine |
|---|---|
| Application not accepted | Medigap Open Enrollment, guaranteed issue rights, medical underwriting and state protections. |
| A medical claim is not paid | Whether Original Medicare covered the service, the policy benefits, effective dates and any valid waiting period. |
| A policy is ending | Premium payment, application accuracy, insurer status and the written termination reason. |
When health cannot be used to refuse your application
The federal Medigap Open Enrollment Period lasts six months, starting the first month you are at least 65 and enrolled in Part B. During that period, an insurer cannot use your health to deny a policy it sells or charge more for health reasons. Certain guaranteed issue events provide separate protections. State law may provide more rights.
Outside protections, an insurer can generally use medical underwriting to decide whether to accept an application and what to charge. Turning 65 while already on Medicare because of disability creates the age-65 Medigap enrollment opportunity; rights before 65 vary by state.
Pre-existing conditions and claims
Open enrollment does not always eliminate a permitted waiting period for coverage related to a pre-existing condition. Prior creditable health coverage can reduce or remove that waiting period under applicable rules. Guaranteed issue rights include coverage of pre-existing conditions. Ask the insurer to explain any proposed waiting period before purchase.
Medigap usually pays specified costs left by Original Medicare. A plan letter does not promise payment for every service, excluded routine benefit or bill beyond its terms. If a claim is denied, compare Medicare’s decision with the Medigap explanation and ask which provision caused the denial.
What to do next
- Get the written reason, policy provision and response deadline.
- For an application, provide evidence of any protected enrollment right.
- For a bill, confirm that the claim and Medicare payment information reached the insurer correctly.
- Follow the insurer’s review process; contact the state insurance department for unresolved policy disputes.
- Keep existing coverage until a replacement is approved and its start date confirmed.
Standardized Medigap policies are generally guaranteed renewable if premiums are paid. Developing a health condition alone does not let the insurer cancel the policy.
Related coverage questions
- What Is Medigap? Benefits, Costs and Enrollment
- How to Compare Medigap Policies
- Medigap Comparison Chart: Benefits and 2026 Cost Limits