Eligibility for Medicare Supplement Insurance
Are you thinking about getting a Medicare Supplement plan, also known as Medigap? You might already be aware that this insurance can pay for some of your Original Medicare, Part A and Part B, costs. There are certain times and situations when you’re eligible for Medigap.
Because Medigap policies supplement your Medicare coverage, you must be enrolled in Medicare Part A and Medicare Part B to be eligible for this type of policy.
How can enrollment periods affect my eligibility?
The best time to enroll in a Medicare Supplement plan is generally during your Medigap Open Enrollment Period—for most people, this period starts the month that you turn 65 and have Medicare Part B, and goes for six months. This is when you can get any Medigap plan that’s available in your area, regardless of any health issues you may have. The insurance company can’t charge you more if you have health problems.
You can apply for a Medigap plan anytime, but if you apply outside of your Medigap Open Enrollment Period, the insurance company can require you to undergo medical underwriting. It might charge you a higher rate if you have health problems, and there’s no guarantee that a plan will accept you. There are exceptions; you have guaranteed-issue rights in certain situations.
Am I eligible if I’m under age 65?
Federal law does not require insurance companies to sell Medigap policies to people under 65, but many states do have this requirement.
If you’re under 65 and have Original Medicare due to a disability, amyotrophic lateral sclerosis (ALS), or end-stage renal disease (ESRD), your state may let you apply for a Medicare Supplement policy when you’re under 65. However, depending on where you live, you might not be able to purchase the policy option you want—or any Medigap policy—until you turn 65.
Some insurance companies will sell Medigap policies to people under 65 even when it’s not required by law. These companies may charge more for the policy or deny coverage for preexisting conditions, so you should review your rights under state law before making a purchase. You can get this information by calling your State Health Insurance Assistance Program.
Am I eligible if I have a Medicare Advantage plan?
In general, Medigap policies don’t work with Medicare Advantage (also called Medicare Part C) plans. However, you may be able to buy a Medigap policy under certain situations, such as if you are eligible for “trial rights.”
Trial rights allow you to join a Medicare Advantage plan for a trial period during your Initial Coverage Election Period. If you’re not happy with the plan, you can return to Original Medicare anytime within the first 12 months. Before returning to Original Medicare, you can apply for any Medigap policy that is sold in your state. Your new policy should go into effect the same time your Medicare Advantage plan enrollment ends to avoid breaks in your coverage.
You also have the right to buy certain Medigap polices in other special situations. Here are just a few examples (this is not a complete list):
- Your Medicare Advantage plan leaves Medicare.
- Your Medicare Advantage plan stops providing services in your area.
- You move out of the plan’s service area.
Under these circumstances, you may be eligible to buy any Medigap Plan A, B, C, F, K, or L that is sold in your state. Remember, you still must return to Original Medicare in order to get a Medigap policy.
Important note: It’s illegal for anyone to sell you a Medigap policy if he or she knows you’re in a Medicare Advantage plan, unless your coverage in this plan will end before the Medigap policy goes into effect.
Am I eligible if I have coverage through Medicaid?
Medicaid typically doesn’t work with Medicare Supplement plans. In fact, it’s generally illegal for insurance companies to sell Medigap policies to anyone who is receiving Medicaid.
If you’d like to keep your Original Medicare, but want to see if you can get coverage for some of the costs you’re responsible for, you may want to check out which Medicare Supplement plans are available to you. I can help you with that.
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