“Medigap deny health conditions” is a common search phrase for a reason—many people don’t realize that certain pre-existing health issues can lead to a Medigap application denial (depending on when you apply). This guide lists the common conditions that raise red flags and offers tips to improve your chances of Medigap approval.

Note: If you are already on a Medigap plan, insurance providers cannot deny you treatment or charge you more for your condition. The “deny” we are talking about in this article is about not approving your Med Supp application for coverage based on pre-existing conditions.

Can You Be Denied Medigap Coverage Because of Pre-existing Health Conditions?

Many people believe Medicare Supplement (Medigap) plans are guaranteed to accept anyone. That’s true during your Initial Enrollment Period (your first six months of having Medicare Part B). But after that period, insurance companies in most states can ask health questions and even deny your application based on your past medical history. Missed your open period? You may still have options. Read our article, “Help! I’ve Missed My Medigap Initial Enrollment Period. What Should I Do?”.

So, if you’re applying outside that protected window like your initial open enrollment, your health can play a big role. Some states offer special protections (like New York’s year round guaranteed issued coverage and the Birthday Rule), but in most of the country, underwriting rules apply. See our Ultimate Guide to Medigap Underwriting.

When Does Medical Underwriting Apply for Medigap?

Medical underwriting kicks in any time you apply for a Medigap plan outside your Initial Enrollment Period or outside a guaranteed issue right. That means switching plans later in life or applying for the first time when you’re older can expose you to health-related denials. (Source: Medicare.gov)

Even switching from one Medigap insurer to another can trigger underwriting unless you qualify for a special rule or a state rule (we’ll cover those later). Always double-check your rights in your state before you apply. Try our Ai Medigap Underwriting Checker to preview your odds of being approved or call us at 800-930-7956 for free support.

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Health Conditions That Can Lead to Medigap Denial

Here are the common health conditions that can trigger a denial under medical underwriting when applying for Medigap:

  • Autoimmune Disorders: Lupus.
  • Cancer: Any cancer diagnosis or treatment within the last 2+ years, Kidney cancer, Leukemia.
  • Cardiovascular Conditions: Atrial fibrillation, Cardiomyopathy, Coronary Artery Disease, Heart failure (including Congestive Heart Failure), Major heart surgeries (e.g., bypass, valve replacement), Stroke, Transient Ischemic Attack (TIA).
  • Kidney Disorders: Chronic Kidney Disease, End-Stage Renal Disease (ESRD), History of kidney transplant.
  • Liver Conditions: Cirrhosis, Liver fibrosis.
  • Mental Health & Substance Use: Bipolar disorder, Drug or alcohol abuse, Schizophrenia.
  • Metabolic & Endocrine Disorders: Insulin-dependent diabetes with complications.
  • Neurological Disorders: Alzheimer’s disease, Amyotrophic Lateral Sclerosis (ALS), Dementia, Multiple Sclerosis (MS), Parkinson’s disease.
  • Other Serious Conditions: AIDS, Organ transplants, Osteoporosis with fractures.
  • Respiratory Conditions: Chronic Obstructive Pulmonary Disease (COPD), Cystic Fibrosis, Emphysema, Lung conditions requiring oxygen or nebulizer.

NOTE: Even though Medigap doesn’t cover prescription drugs at the pharmacy, some insurance providers may ask you to list your current drugs on the application during underwriting. They may not approve you if you take medications listed on their “uninsurable” drug list, such as Aricept, Copaxone, Humira, Methotrexate, Aubagio, Donepezil, Avonex, Rebif, and others. Not all insurance providers will ask you to list your prescription drug use.

Automatic decline conditions vary by insurer but are fairly consistent on major chronic illnesses. This is why it is so important that you work with us to enroll in Medigap when you are first eligible. Feel free to call us at 800-930-7956.

We recommend using our Instant Medigap Underwriting Checker to see if you’re a good candidate for underwriting approval ahead of time.

What If I Have One of These Health Conditions?

If you’re currently outside your Medigap Initial Enrollment Period and don’t have a guaranteed issue right, you may still be able to get coverage depending on the insurance provider. This list above includes the most commonly mentioned health issues by insurance companies, but depending on your specific condition and when the treatment took place, some insurers may still approve you.

We recommend using our free Instant Medigap Underwriting Checker to estimate your approval odds. It’s fast, anonymous, and can help you make smarter decisions before applying. If you are not sure, give us a call and we can check specific underwriting guidelines to point you to the company that will give you the best chance at approval.

Recent Treatment = Underwriting Decline?

Medicare Supplement Insurance providers are typically very cautious about recent or ongoing health conditions. For example, someone who had back surgery 10 years ago is often approved, while someone currently undergoing physical therapy for back pain is usually declined. Insurance companies prefer conditions that are resolved. If surgery fixed the problem, they’re more willing to offer coverage. But if you’re still in treatment—like physical therapy—they worry that surgery or further complications may be needed down the road, and they don’t want to take that risk by approving the application.

Those subject to medical underwriting should apply for Medigap after completing recommended surgeries or treatments. Those with certain major issues like heart attack can be approved if they have been 2 years treatment and symptom free. No insurance provider will approve you if you have a recommended treatment or surgery that has yet to take place.

Can I Still Use the Birthday Rule to Get Medigap in My State?

Some states have more flexible rules that let you switch Medigap plans without answering health questions. It’s called the Medigap Birthday Rule, and it’s now available in over ten states including California, Idaho, Illinois, Nevada, Kentucky, Louisiana,  Maryland, Oklahoma, Oregon, Utah, Virginia and Wyoming. Read all about the Medigap Birthday Rule State by State. Also, we suggest taking a look at our full article: Medicare Insurance Switching: Ultimate Guide to see all your switching options.

This is a great way to change plans with guaranteed acceptance. However, if you currently do not have a Medigap plan, this rule won’t apply to you and you will have to apply with Medical Underwriting.

How to Improve Your Chances of Medigap Approval

There are smart ways to improve your chances:

  • Apply during a protected period, like your Initial Enrollment or state-specific window which lets you skip underwriting and be guaranteed to be approved.
  • Work with a licensed Medigap expert (like us at Senior65.com) to find insurers with more lenient underwriting.
  • Complete treatment before applying. Insurance companies rarely approve someone undergoing treatment for major issues.
  • Avoid coverage gaps so you’re never left without supplemental insurance.

Not sure where to start? Call us at 800-930-7956. There’s never a fee to work with us.

FAQs: Medigap Denial & Health Conditions

Q: Can I get Medigap if I’m overweight?
A: Possibly. Some insurer has a height/weight chart. Some are stricter than others.

Q: Does cancer automatically mean denial?
A: If you’ve been cancer-free for 2+ years, you might be eligible.

Q: Can I switch Medigap plans if I develop a new condition?
A: Usually not without underwriting, unless your state has a special rule.

Q: Is Medigap easier to get than Medicare Advantage?
A: Medigap offers more flexibility once you are approved, but it’s harder to qualify for it if you are outside your initial enrollment period (6 months from your initial Part B enrollment at age 65). Medicare Advantage NEVER asks health questions.

Next Steps: How to Compare Medigap Plans If You Have Health Concerns

Your health shouldn’t stop you from getting great coverage—and sometimes, timing is everything. Use our Instant Medigap Quote Tool to see real prices in your area.

Still not sure if you’ll be approved? That’s where our Underwriting Checker comes in.

Want help figuring it out? Give us a call at 800-930-7956. We’ll explain your choices clearly, with no pressure and no cost.