4 Ways to Avoid Being Rejected or Overcharged for Medigap

If you’ve lost coverage that may act like Medigap. A separate 63 days begins after you’ve lost job-based health insurance that’s considered secondary to Medicare. That includes the termination of plans such as COBRA, a group plan at a small company or retiree coverage.

If you’re 65 or older and you or your spouse works for a company with less than 20 employees, the employer’s insurance is generally considered secondary to Medicare. You might sign up for Part B while you still have the employer’s coverage since Medicare is the primary coverage but can delay signing up for Medigap until the employer’s coverage stops.

When your Medigap policy ends through no fault of your own. For example, if your Medigap insurer goes out of business, you have up to 63 days to apply for another Medigap policy after your coverage is terminated.

If you move out of your Medicare Advantage plan’s service area or your plan stops giving care in your area. You can also switch if your Medicare Advantage plan leaves Medicare. But like other scenarios, you have time limits when applying for a Medigap policy.

If your Medicare Advantage plan has significant changes to its provider list. The Centers for Medicare & Medicaid Services (CMS) will determine whether the changes are substantial enough to qualify for a special enrollment period. Your plan may tell you whether you’re eligible, or you can ask Medicare.

If an insurance agent misled you or you were switched to a Medicare Advantage plan through fraud, you have the right to return to original Medicare and buy a Medigap policy without health questions.

2. Know your state’s rules

A growing number of states (about half) have laws that go further than the minimum federal standards. But most of these rules don’t apply to Medicare enrollees without Medigap.

Connecticut, Massachusetts and New York allow you to buy a Medigap policy anytime, regardless of your health. The private companies that issue the policies also must charge everyone the same rate regardless of age (called “community rating”).

In these states, if you have a Medicare Advantage plan and realize that it doesn’t meet your needs, you can switch to original Medicare and easily get a Medigap policy without having to pay more.

In Minnesota, legislation that took effect in 2026 put in place a guaranteed issue open enrollment period for residents ages 65½ to 70. This means you can purchase one of the state’s two Medigap plans during Medicare’s annual open enrollment season, Oct. 15 to Dec. 7. Federal law covers many people who turn 65 and get Part B through their six-month Medigap open enrollment period.

Enrollees can use this option only once. They’ll be charged higher rates for the rest of their lives than if they had enrolled when they were younger, but they can’t be rejected for health problems.

Insurance agents expect this to open a door for longtime Medicare Advantage enrollees who are past their 12-month trial period and were facing roadblocks to getting original Medicare, and those in original Medicare who didn’t buy a Medigap plan when they were first eligible.

Maine requires insurers to offer Medigap Plan A, which has the least amount of coverage, to anyone age 65 or older, regardless of health, for one month every year. The insurer decides which month.

Maine also extends the Medicare Advantage trial period in federal law from 12 months to 36 months. That means you have up to three years to switch back to original Medicare and get any Medigap policy without denials or extra charges for existing health conditions.

A Rhode Island law that took effect in 2026 allows for an annual open enrollment season (Oct. 15 to Dec. 7) for anyone who has had Medigap or Medicare Advantage coverage without a break of more than 90 days.

Washington state lets you change Plan A companies or switch among Plans B to N at any time if you haven’t had a gap of more than 90 days in coverage.

Birthday rule states. These state laws allow people who already have Medigap policies to switch plans around the time of their birthday without requiring them to answer questions about their health.

Some will let you choose a plan with equal or lesser benefits; others want you to stay with the same type of plan. Sometimes you can change insurers; other times you must shop within your company’s offerings.

Depending on the state, you generally have 30 to 63 days to switch policies.

Joanne Giardini-Russell, CEO of Giardini Medicare, an independent insurance agency in Howell, Michigan, that handles Medicare supplement policies in 27 states, says helping people negotiate the “birthday windows” is a growing part of her business.

“Birthday rules exist, and they are more prevalent,” Giardini-Russell says. “You have to get creative and do what your state allows.”

Delaware, Indiana and West Virginia laws took effect this year. Virginia’s coverage started in 2025. New Mexico’s will begin in 2027.

Some states, such as West Virginia, require residents to have their current Medigap plan for at least 24 months before they can switch to a policy with equal or lesser benefits.

Missouri’s law is similar to a birthday rule but centers around a Medigap policy’s anniversary date. It lets you change insurers offering the same lettered plan.

Get the details. Contact your State Health Insurance Assistance Program (SHIP). Most state insurance departments have Medigap buyers’ guides that explain the rules and may even list premiums for each insurer.

Keep in mind that many of these rules apply only to people who are 65 or older. If you’re younger than 65 and have Medicare because of a disability, you may have a harder time qualifying for coverage. The pre-65 Medigap rules vary significantly by state.

3. Shop for an insurer that covers your medical condition

When you apply for a Medigap policy outside of your Medigap open enrollment period, you won’t have a guaranteed issue right in most states, so you’ll probably have to answer questions about your health.

You often start by filling out an online form, Giardini-Russell says.

“It’s just a series of questions, 10 to 20 questions depending on the carrier, like, ‘Have you been diagnosed in the last three years with a cancer or blood cancer? Have you had a stroke, heart attack?’ All those big things.”

Don’t be tempted to lie, she says. Most insurers use third-party vendors to verify medical records.

No uniformity. Health conditions that aren’t considered pre-existing vary considerably from insurer to insurer.

The following is a list of chronic conditions that could cause you to be denied coverage, according to health policy nonprofit KFF’s review of Medigap applications of leading insurers:

• Alzheimer’s disease
• Asthma
• Cancer
• Congestive heart disease
• Diabetes with complications
• End-stage renal disease, also known as kidney failure
• High blood pressure, also known as hypertension
• Limitations of daily activities and
• Stroke

Or you could be offered the supplement insurance but at a much higher premium.

“Some carriers have something called a ‘table two rating,’ which, if you’re not in the best of health but you’re not a denial, they will just charge you maybe double or triple of a regular premium,” says Samuel Asher Schwartz, a Miami-based Medicare broker who works with Medicare Advantage and Medicare supplement policies in about 20 states. “But most carriers will just say you’re in the plan or you’re not.”

You also could get hit with higher Medigap premiums if you have health conditions such as bipolar disorder, diabetes with no complications and osteoporosis treated with infusion medication. Giardini-Russell says conditions such as high blood pressure and high cholesterol that are under control may be acceptable.

You may be asked if a medical professional prescribed any of the following procedures: back or spine surgery, cancer surgery, heart surgery, joint replacement, organ transplant or vascular surgery. Some insurers may deny coverage if you’ve been hospitalized in the past 90 days or if you live in a nursing home, she says.

If you were diagnosed with cancer several years ago or had surgery a while ago, you still may be able to buy a policy, depending on the insurer.

“If you had a knee replacement and you’re doing great today and you’ve been cleared from physical therapy — you’re done — then it’s fine,” Giardini-Russell says. “But people who say, ‘I have a knee replacement coming up,’ or ‘I’m currently going through physical therapy for my shoulder, but I’m almost done,’ we can’t put in an application in until they’re done, cleared by the doctor, everything’s good [and] they’re dismissed from PT.”

If you’re trying to get a Medigap policy when you don’t have a guaranteed issue right and you have preexisting health conditions, a SHIP counselor can help you.

If you’re looking for an agent, consider one who works with several companies and knows their underwriting criteria. Be aware that insurance companies often encourage sales of Medicare Advantage plans by offering higher commissions for them than for Medigap plans, and agents don’t get incentives for enrolling a client in original Medicare.

Giardini-Russell recently got a call from a California couple, ages 80 and 75 with significant medical conditions, who are paying a combined $1,000 a month for their Medigap plans. She’s confident she can cut their premiums in half by shopping around and submitting their applications during California’s birthday window.

For a list of insurers that sell Medigap policies in your area, visit Medicare’s Medigap Plan Finder.

4. Don't let your policy lapse

If your Medigap policy was issued after 1992, your insurer must renew it annually, even if you have health problems.

Guaranteed renewal with a caveat. If you fail to pay your premiums, the company can cancel your plan. Since private insurers sell Medigap policies, you pay your Medigap premium separately from your Medicare premium.

To avoid an inadvertent lapse in payments, have your premium amount transferred automatically from a bank account or credit card. If you write a check, make sure someone will pay the bill if you become incapacitated.

Look for discounts. Unlike Medicare itself, Medigap plans may offer a little money off if you pay annually instead of monthly, use electronic funds transfer, have both you and your spouse on the same plan or don’t smoke.