Blog / Medigap

Can I be denied Medigap for pre-existing conditions?

Inside your Medigap open enrollment window, no company in Texas can say no. Outside it, health questions apply. Here is how the timing works.

Updated September 3, 2026 · 3 min read · by Gerino Alejos

It depends on when you apply. Inside your Medigap open enrollment window, no company in Texas can turn you down for your health. Outside it, companies can ask about your health. Medicare Advantage works the other way; see why Advantage plans cannot turn you down.

Inside your six month window: no

Medigap open enrollment is a six month window. It starts when your Part B begins, at or after 65. Part B pays for doctor visits and outpatient care.

During those six months, no company in Texas can decline you or charge you more because of your health.

A pre-existing condition is a health problem you were treated for or diagnosed with before the policy starts. If you had at least six months of prior creditable coverage, meaning earlier coverage that counts toward this rule, the company also cannot impose a waiting period for one.

Without that prior coverage, a waiting period of up to six months is possible. It applies to conditions treated or diagnosed in the six months before your policy starts.

Outside the window: yes

Outside the guaranteed issue situations below, Texas allows medical underwriting on Medigap policies. Underwriting means the company can look at your health history and say no.

That means an application with health questions. The company can decline you, charge you more, or leave a condition out of the coverage.

What underwriting looks at

It varies by company, which is why an agent who works with several companies helps here. They usually ask about these areas.

• Recent hospital stays or surgeries, and any already scheduled
• Ongoing treatment for cancer, or for heart, lung or kidney conditions
• Insulin use and diabetes complications
• Oxygen use
• Certain conditions of the brain and nervous system
• The medicines you take, which often tell them more than the questions do

Companies differ in what they will accept. One company's decline can be another company's approval.

The guaranteed issue situations

Outside your window, some situations still give you the right to buy without underwriting.

• Your Advantage plan leaves your area or loses its contract
• You move out of your plan's service area, the counties where the plan operates
• Trial right (a one time chance to go back): you joined Advantage when first eligible at 65 and leave within twelve months
• Trial right: you dropped a Medigap policy to try Advantage and go back within twelve months
• Employer or union coverage ending, in certain cases
• The company misled you or went out of business

These rights are time limited, usually 63 days from the event. See moving from Advantage to a supplement.

If you cannot pass underwriting

You still have options. They are just different ones.

• Apply with a different company. Standards vary a lot.
• Ask about a plan letter with lighter underwriting at some companies, or a high deductible version. A deductible is what you pay before the plan pays. See the high deductible supplement.
• Look at a Medicare Advantage plan with a low out of pocket maximum, the most you can pay in a year, and a wide network of doctors and hospitals. Advantage plans cannot decline you.
• If you qualify for Medicaid or a savings program, look at a dual eligible plan, meaning you have both Medicare and Medicaid. See D-SNP plans.

Apply and get an approval in hand before you drop anything you have now. Never cancel first.

If you want help before you apply, call our McAllen office at (956) 687 3334, or enter your ZIP code in the form on this page.

Gerino Alejos

Licensed insurance agent · License 3128710 · NPN 18243381

Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.