Can I still get a Medicare Supplement if I have COPD or emphysema?

When you have a health condition like COPD or emphysema, getting Medicare Supplement insurance can be a huge point of concern.  

You wonder:

• Will I be able to get Medigap insurance?
• If I do get approved, how much will it cost?
• How much would it cost if I didn’t have Medigap insurance and had an unexpected medical bill?

It’s all troublesome, and when you have a health condition like COPD or emphysema, the situation can feel uncertain and stressful.

We’d like to share how you can get a Medicare Supplement even if you do have COPD or emphysema.

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Getting a Medigap Plan with COPD or Emphysema – Open Enrollment and Guaranteed Issue

If you have COPD or emphysema, and you don’t think you’d ever get approved for Medigap insurance, you can take advantage of open enrollment and Guaranteed Issue (GI).

Open enrollment is when you’ve signed up for Medicare Part B for the first time. In this situation, you don’t have to answer any health questions.

Guaranteed Issue (GI) is a special situation when you've lost your current coverage. Here are two common examples:

• You’re in a Medicare Advantage Plan, and you move out of the plan’s service area.
• Your employer’s group health plan is ending.

Read more about open enrollment and Guaranteed Issue here.

So, if you qualify for open enrollment or Guaranteed Issue (or both at the same time), you don’t have to pass medical underwriting at all.

To sum up, if you’re signing up for Medicare Part B for the first time, or you’re losing your health insurance for some reason, you will most likely be eligible to get a Medicare Supplement without having to answer and pass health questions.

How does COPD/emphysema affect my Medicare Supplement eligibility?

There are certain health conditions that often show up on a Medicare Supplement application. You must be able to answer the questions appropriately in order to even send in your application.

So, if you have COPD or emphysema, you might be wondering what those questions are so you can determine if you’d be approved.

On many applications, the question doesn’t directly say “COPD” or “emphysema.” It often generalizes these conditions as lung or respiratory disorders.

Unfortunately, most companies will not accept your application if you have COPD or emphysema. However, some companies will, but only under certain circumstances.

Some common ways to be declined would be:

1. If you use a nebulizer or oxygen (sometimes even within the past 2 years)
2. If you take more than 3 medications
3. If you also use tobacco

Some companies may accept you if you have COPD or emphysema, but they give you a “modified” rate. This means you pay a higher rate class for having the condition, and you also must fit into certain guidelines, like the ones listed above.

Finally, if you take certain medications, some companies will decline you. For example, DuoNeb, Prednisone, Atrovent, or Spiriva can often be cause for decline.

The bottom line is that while having COPD and emphysema makes it more difficult to pass medical underwriting, sometimes there’s still a chance.

You won’t know if you’ll be accepted unless you try.

Contact us to find out if you’d be accepted for Medigap coverage.