One of the biggest concerns people have about Medicare Supplement Insurance, also called Medigap, is whether they can qualify for coverage as they get older.
Perhaps you turned 65 several years ago and chose a Medicare Advantage plan. Now you want to switch to Original Medicare with Medigap because you would like greater freedom to choose your doctors.
Or maybe you already have a Medigap policy but want to change insurance companies to find a lower monthly premium.
You might be wondering whether an insurance company can deny your application because you have diabetes, heart disease, cancer, or another health condition.
The answer depends on your situation.
Yes, it is possible to get Medigap without medical underwriting after age 65. However, you must qualify for a protected enrollment period, a guaranteed issue right, or another protection available under your state's laws.
In some situations, you may be able to purchase a Medigap policy regardless of your health. In others, the insurance company may review your medical history before deciding whether to approve your application.
Understanding these rules is important because your ability to purchase Medigap can change over time.
What Is Medical Underwriting?
Medical underwriting is the process an insurance company uses to review your health before deciding whether to offer you a policy.
When you apply for Medigap outside certain protected enrollment periods, an insurance company may ask questions about your health.
These questions might include whether you have been diagnosed with certain medical conditions, received recent treatment, undergone surgery, or been advised to have a medical procedure.
The company may also review your prescription medications or medical records, where permitted.
Based on that information, the insurance company may approve your application, charge a higher premium where allowed, or deny coverage.
For example, someone who has been treated for a serious heart condition may have more difficulty qualifying for a new Medigap policy than someone with no significant medical history.
However, medical underwriting is not always required.
Federal and state laws provide important protections that can allow eligible people to purchase Medigap without being denied because of their health.
1. Your Six-Month Medigap Open Enrollment Period
The most important time to purchase Medigap is during your six-month Medigap Open Enrollment Period.
This period begins the first month you are both:
- Age 65 or older.
- Enrolled in Medicare Part B.
During this period, insurance companies generally cannot deny you a Medigap policy because of your health or charge you a higher premium because of existing health conditions.
For example, suppose you turn 65 in June and your Medicare Part B coverage begins June 1.
Your six-month Medigap Open Enrollment Period generally runs from June through November.
During those six months, you can apply for any Medigap policy sold in your state for which you are eligible, regardless of your health history.
This protection applies even if you have serious or ongoing medical conditions.
What If You Enroll in Medicare Part B After Age 65?
Your Medigap Open Enrollment Period does not necessarily begin on your 65th birthday.
Suppose you continue working until age 68 and remain covered by your employer's health insurance.
You delay enrolling in Medicare Part B because you have qualifying employer coverage.
When you retire at age 68, you enroll in Part B for the first time.
Your six-month Medigap Open Enrollment Period generally begins when your Part B coverage starts, even though you are already 68.
This means you may still have the opportunity to purchase Medigap without medical underwriting several years after turning 65.
The key is when you first become both 65 or older and enrolled in Medicare Part B, not simply your age.
Your Medigap Open Enrollment Period is different from Medicare's Annual Enrollment Period, which runs from October 15 through December 7.
The annual Medicare enrollment window does not automatically give everyone the right to purchase Medigap without medical underwriting.
2. Guaranteed Issue Rights: When Insurance Companies Must Accept You
Even after your six-month Medigap Open Enrollment Period ends, certain situations may give you a guaranteed issue right.
A guaranteed issue right is a legal protection that requires an insurance company to offer you certain Medigap coverage without denying your application because of your health.
These protections are designed to help people who lose certain coverage or experience specific changes in their Medicare insurance.
However, not every situation qualifies.
Federal guaranteed issue rights apply to particular circumstances and may limit which Medigap plans you can purchase.
Let's look at some common examples.
Your Medicare Advantage Plan Leaves Medicare
Suppose you have a Medicare Advantage plan, but the insurance company decides to stop offering that plan in your area.
If your coverage ends because the plan leaves Medicare or stops serving your location, you may qualify for a guaranteed issue right.
This may allow you to return to Original Medicare and purchase certain Medigap policies without medical underwriting.
The exact plans available to you depend on your eligibility and applicable rules.
You Move Outside Your Medicare Advantage Plan's Service Area
Medicare Advantage plans generally operate within specific geographic service areas.
If you move permanently outside your plan's service area and cannot remain enrolled in that plan, you may qualify for a guaranteed issue right to purchase certain Medigap coverage.
For example, imagine you live in California and move permanently to New Jersey.
Your existing Medicare Advantage plan may not operate in your new location.
Under qualifying circumstances, you may be able to return to Original Medicare and purchase an eligible Medigap policy without medical underwriting.
You Lose Certain Employer or Union Coverage
Some people have Original Medicare along with health coverage through a current or former employer or union.
If that supplemental coverage ends, certain circumstances may give you a guaranteed issue right to purchase Medigap.
However, not every loss of employer coverage qualifies.
The type of coverage, how it ends, and your Medicare enrollment status all matter.
Your Medigap Insurance Company Has Problems
You may qualify for guaranteed issue protections if your Medigap insurance company goes bankrupt and you lose coverage, or if your coverage ends through no fault of your own under certain circumstances.
These protections help prevent you from being left without supplemental insurance because of problems beyond your control.
Your Insurance Company Misled You or Failed to Follow the Rules
In certain situations, you may have a guaranteed issue right if an insurance company or agent misled you about coverage or failed to follow applicable rules.
These situations require specific facts and may involve documentation or a review by the appropriate insurance authority.
If you believe this happened to you, contact your state insurance department or State Health Insurance Assistance Program for help.
3. Medicare Advantage Trial Rights
Federal Medicare rules provide special protections for certain people who try Medicare Advantage and later decide they would prefer Original Medicare with Medigap.
These protections are called trial rights.
There are two important situations to understand.
Trial Right 1: You Joined Medicare Advantage When First Eligible at 65
Suppose you enroll in a Medicare Advantage plan when you first become eligible for Medicare at age 65.
After several months, you decide the plan is not the right fit.
Perhaps your preferred specialist is outside the network, or you would rather use Original Medicare.
If you decide to leave Medicare Advantage within the first year, you may qualify for a federal trial right that allows you to purchase an eligible Medigap policy without medical underwriting.
This protection generally applies when you joined Medicare Advantage upon first becoming eligible for Medicare at age 65.
You must meet the trial right requirements and applicable deadlines.
Trial Right 2: You Dropped Medigap to Try Medicare Advantage
Now imagine you already have Original Medicare with a Medigap policy.
You decide to drop your Medigap coverage and enroll in Medicare Advantage for the first time.
After six months, you realize you preferred your previous coverage.
If you decide to return to Original Medicare within the first year, you may qualify for a trial right.
You generally have the right to purchase your previous Medigap policy if it is still available from the same insurance company.
If that policy is no longer available, you may have the right to purchase certain other Medigap policies.
These protections can be valuable, but they are not unlimited.
A trial right is not a guarantee that you can move between Medicare Advantage and Medigap whenever you want.
You must meet the specific eligibility rules and deadlines.
4. State Laws May Give You Additional Medigap Rights
Federal Medicare rules provide a basic level of consumer protection.
However, some states have laws that make it easier to purchase or change Medigap coverage without medical underwriting.
These protections can vary significantly.
Some states allow beneficiaries to change Medigap policies during certain times of the year. Others provide broader access to Medigap regardless of health.
This is one reason it is important to review the rules in the state where you live.
New York
New York has broad Medigap enrollment protections.
Under New York's continuous open enrollment rules, eligible Medicare beneficiaries can generally purchase Medigap coverage throughout the year without being denied because of their health.
This makes New York different from states where medical underwriting is commonly required outside protected enrollment periods.
Connecticut
Connecticut also has broad Medigap enrollment protections.
Eligible beneficiaries generally have access to Medigap coverage without medical underwriting throughout the year, subject to applicable state rules.
California
California has a Medigap Birthday Rule.
This rule generally allows eligible people who already have Medigap to change to another Medigap policy with equal or lesser benefits during a protected period around their birthday.
The rule can help people shop for lower premiums without medical underwriting.
However, it is not the same as a general right to leave Medicare Advantage and purchase Medigap at any time.
Oregon
Oregon also provides a Medigap Birthday Rule.
Eligible beneficiaries who already have Medigap may have an opportunity to change policies around their birthday without medical underwriting, subject to state requirements.
Missouri
Missouri provides a special anniversary rule for certain Medigap policyholders.
This rule generally allows eligible people to change to the same standardized Medigap plan with another insurance company during a protected period around their policy anniversary.
Other States
Several other states offer additional Medigap protections, including rules for changing policies or obtaining coverage in certain situations.
These laws can change, and their requirements differ.
Some protections apply only to people who already have Medigap. Others may apply more broadly.
Before assuming you must pass medical underwriting, check your state's current Medigap rules.
An independent Medicare broker familiar with your state can help explain which protections may apply.
5. Can You Switch From Medicare Advantage to Medigap After Age 65?
Yes, you may be able to switch, but there are two separate steps to consider.
First, you must be eligible to leave Medicare Advantage and return to Original Medicare.
Second, you must qualify to purchase the Medigap policy you want.
These are not the same thing.
Medicare generally provides opportunities to change Medicare Advantage coverage during certain enrollment periods.
The Annual Enrollment Period runs from October 15 through December 7.
There is also a Medicare Advantage Open Enrollment Period from January 1 through March 31 for people already enrolled in Medicare Advantage.
During eligible periods, you may be able to return to Original Medicare.
However, returning to Original Medicare does not automatically guarantee that a Medigap insurance company will accept your application.
If you do not qualify for a guaranteed issue right, trial right, or state protection, the insurance company may require medical underwriting.
This is why it is important to review your Medigap eligibility before making changes to your current coverage.
You should also consider how you will obtain prescription drug coverage if you return to Original Medicare.
6. Can You Switch From One Medigap Plan to Another Without Underwriting?
Sometimes.
Suppose you purchased Medigap Plan G several years ago.
Your premium has increased, and you want to see whether another insurance company offers a lower price.
Because standardized Medigap plans provide the same basic benefits in most states, comparing premiums from different companies can be worthwhile.
However, federal law generally does not give everyone an automatic right to switch Medigap companies without medical underwriting.
Outside your initial Medigap Open Enrollment Period, the insurance company may review your health before approving a new policy.
Some states provide additional switching protections.
For example, certain birthday or anniversary rules allow eligible policyholders to change coverage during specific periods without medical underwriting.
If you are considering changing Medigap companies, an independent broker can help you compare prices and determine whether underwriting would apply.
Do not cancel your existing Medigap policy until you understand the approval and effective date of any replacement coverage.
7. What If You Have a Preexisting Medical Condition?
A preexisting condition does not always prevent you from purchasing Medigap.
If you qualify for a protected enrollment period or guaranteed issue right, an insurance company generally cannot deny you an eligible Medigap policy simply because you have a health condition.
For example, a person with diabetes, heart disease, or a history of cancer may still be able to obtain coverage during their Medigap Open Enrollment Period.
Outside protected periods, medical underwriting may apply.
The insurance company may ask about your diagnoses, medications, recent hospital stays, and ongoing treatment.
Different insurance companies may have different underwriting guidelines.
This means a person who does not qualify with one company may qualify with another, although approval is not guaranteed.
Also, medical underwriting is different from a preexisting condition waiting period.
Under limited circumstances, a Medigap policy may have a waiting period for coverage of certain preexisting conditions. Prior creditable health coverage may reduce or eliminate that waiting period.
The rules depend on the timing of your enrollment and the coverage you previously had.
8. What If You Are Denied Medigap Coverage?
If an insurance company denies your Medigap application, it does not necessarily mean you have no other options.
The first step is to understand why your application was denied.
You may be able to apply with another insurance company that has different underwriting requirements.
You should also determine whether you qualify for a guaranteed issue right or additional state protection that was not considered.
If you believe your application was denied in violation of your legal rights, you can contact your state insurance department.
Your State Health Insurance Assistance Program, also called SHIP, can provide free Medicare counseling.
Depending on your circumstances, Medicare Advantage may remain an option if you cannot qualify for the Medigap policy you want.
The best next step depends on your current coverage, enrollment rights, healthcare needs, and budget.
9. How to Find Out Whether You Qualify Without Underwriting
Before applying for Medigap, gather a few important details about your Medicare coverage.
You should know when your Medicare Part B coverage began, which insurance plan you currently have, and whether you have recently lost or changed coverage.
You should also know whether you are moving to another state or have experienced a change that may qualify you for special enrollment protections.
Use the following checklist:
- Check your Part B effective date. You may still be within your six-month Medigap Open Enrollment Period.
- Review your current coverage. Certain losses of Medicare Advantage, employer, or supplemental coverage may create guaranteed issue rights.
- Check for trial rights. If you recently joined Medicare Advantage for the first time, special protections may apply.
- Review your state's laws. You may have additional enrollment or switching rights.
- Compare insurance companies. If underwriting applies, different insurers may have different application requirements.
- Confirm your deadlines. Some guaranteed issue rights have limited application windows, often involving 60- or 63-day periods.
Keep any letters showing that your coverage ended or changed. These documents may be needed to prove that you qualify for a guaranteed issue right.
An independent Medicare broker can help you review these details and identify which insurance companies and Medigap policies may be available.
Frequently Asked Questions
Can I get Medigap at age 70 without medical underwriting?
Yes, in certain circumstances. If you first enroll in Medicare Part B at age 70, your six-month Medigap Open Enrollment Period generally begins at that time. You may also qualify through a guaranteed issue right or state protection. Otherwise, underwriting may apply.
Can I get Medigap at age 75 or 80?
Yes. There is no general federal maximum age for purchasing Medigap. However, medical underwriting may apply unless you qualify for protected enrollment rights or live in a state with broader protections.
Can I switch from Medicare Advantage to Medigap during AEP without health questions?
Not automatically. The Annual Enrollment Period allows eligible Medicare coverage changes, but it does not give everyone a federal right to purchase Medigap without underwriting.
Can I change Medigap insurance companies every year?
You may apply to change companies, but approval may depend on medical underwriting. Some states provide special switching rights that make changing policies easier.
Is Medigap guaranteed issue every year?
No. Federal Medigap Open Enrollment is generally a one-time six-month period. Additional guaranteed issue rights arise only in qualifying situations, although some states offer broader protections.
Can I be denied Medigap because I have diabetes?
Outside protected enrollment periods, an insurance company may consider diabetes and other medical conditions during underwriting. During your Medigap Open Enrollment Period or when you have an applicable guaranteed issue right, the company generally cannot deny eligible coverage because of diabetes.
The Bottom Line: Age Alone Does Not Determine Your Medigap Eligibility
Getting Medigap without medical underwriting after age 65 is possible.
Your eligibility depends on when you enrolled in Medicare Part B, whether you qualify for a federal guaranteed issue or trial right, and the protections available in your state.
For some people, purchasing Medigap without health questions is straightforward. For others, the process may require reviewing medical underwriting rules and comparing insurance companies.
The most important step is to understand your rights before making changes to your Medicare coverage.
At Beacon Senior Health Advisors, we help individuals understand their Medicare enrollment rights, review Medigap eligibility, and compare available coverage based on their healthcare needs and budget.
As independent Medicare insurance advisors, our goal is to help you understand your choices rather than assume one type of coverage is right for everyone.
If you are considering Medigap after age 65, visit Beacon Senior Health Advisors to learn more or request a consultation.
Beacon Senior Health Advisors
Guiding you. Securing your future.
Sources and References
Primary reference: Centers for Medicare & Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC), Choosing a Medigap Policy. The guide explains Medigap Open Enrollment, guaranteed issue rights, trial rights, and purchasing protections.
Additional official resources:
- Medicare.gov: Medigap
- Medicare.gov: When Can I Buy Medigap?
- Medicare.gov: Guaranteed Issue Rights
- Medicare.gov: Compare Medigap Policies
- State Health Insurance Assistance Programs
This article is for educational purposes only. Federal and state Medigap laws, enrollment deadlines, available policies, and insurance underwriting requirements may change. Some guaranteed issue rights apply only to certain Medigap plans. Always confirm your eligibility and applicable deadlines before changing or canceling existing coverage.
Beacon Senior Health Advisors is not affiliated with or endorsed by the U.S. government or the federal Medicare program.