Eligibility for Medicare Supplement (Medigap) Plans
Last Updated : 09/16/20188 min read
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, but may be wondering when you’re eligible for this coverage. There are certain times and situations when you’re eligible for Medigap.
Here’s an overview of how eligibility for Medigap coverage works.
When am I eligible for Medicare Supplement coverage?
Because Medicare Supplement policies complement your Original Medicare coverage, you must be enrolled in Part A and Part B to be eligible for this type of policy. You’ll also need to stay enrolled in Original Medicare for your hospital and medical coverage. Medicare Supplement plans aren’t meant to provide stand-alone health coverage; these plans just help with certain out-of-pocket costs that Original Medicare doesn’t cover.
If you’re under 65 and have Medicare because of disability, end-stage renal disease, or amyotrophic lateral sclerosis, your eligibility for Medicare Supplement coverage may depend on the state that you live in. Not every state offers Medicare Supplement plans to beneficiaries under 65 (see the section below for more information on Medicare Supplement eligibility if you’re under 65).
In addition, keep in mind that Medicare Supplement plans don’t include prescription drug benefits (Medicare Part D). In the past, some Medicare Supplement plans may have included this coverage, but plans sold today don’t include prescription drug benefits. If you have an older Medicare Supplement policy with prescription drug coverage, make sure this coverage is “creditable” (as good as the Part D benefit), or you could pay a late-enrollment penalty later on if you sign up for Part D later on.
Since Medigap plans don’t include prescription drug benefits, if you’re enrolled in Original Medicare and want help with prescription drug costs, you can get this coverage by enrolling in a stand-alone Medicare Prescription Drug Plan.
How can enrollment periods affect my eligibility for Medicare Supplement plans?
The best time to enroll in a Medicare Supplement plan is generally during your Medicare Supplement 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 Medicare Supplement 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 or deny you coverage because of pre-existing conditions. Your special protections during this period are known as “guaranteed-issue rights.”
Keep in mind that even though a Medicare Supplement insurance company cannot reject your enrollment for health reasons, the company is allowed to make you wait up to six months before covering your pre-existing conditions. After this six-month waiting period is over, the plan will cover your pre-existing conditions. This pre-existing condition waiting period may apply even if you enroll in a Medicare Supplement plan during your Medicare Supplement Open Enrollment Period.
After your Medicare Supplement Open Enrollment Period is over, you can apply for a Medicare Supplement plan anytime, but if you apply without guaranteed-issue rights, 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. For example, if your Medicare Supplement insurance company goes bankrupt or misleads you, you may be able to change Medicare Supplement plans with guaranteed issue.
Am I eligible for a Medicare Supplement plan if I’m under age 65?
Federal law does not require insurance companies to sell Medicare Supplement policies to people under 65, but many states do have this requirement. If you’re not sure whether Medicare Supplement insurance is available in your state, give Medicare.com a call at the phone number on this page, and licensed insurance agent can help you double-check the rules for your state. You can also contact your state’s insurance department for more information.
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 Medicare Supplement policy—until you turn 65. As mentioned above, the best time to enroll in a plan is during your Medicare Supplement Open Enrollment Period, when you have guaranteed-issue rights. If you’re applying for a Medicare Supplement plan and you’re under 65, you may not be able to get any plan you want with guaranteed issue.
Some insurance companies will sell Medicare Supplement policies to people under 65 even when it’s not required by law. These companies may charge more for the policy or deny coverage because of 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. Or, call Medicare.com at the phone number on this page to go over your questions and plan options with a licensed insurance agent.
Am I eligible for a Medicare Supplement plan if I have a Medicare Advantage plan?
Medicare Supplement policies don’t work with Medicare Advantage plans. If you decide to switch from Original Medicare to a Medicare Advantage plan, you may want to consider dropping your Medicare Supplement plan, since you’ll be paying for benefits that can’t be used with your Medicare Advantage plan. If you’re not sure whether you may want to go back to Original Medicare, you should know that it can be difficult to get back the same Medicare Supplement plan later on if you have health problems and don’t have guaranteed-issue rights.
If you switch to Medicare Advantage (also known as Medicare Part C) and want to switch back to Original Medicare later on, you may be able to buy a Medicare Supplement 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 one-year trial period if you are enrolling in Medicare Part C for the first time. If you’re not happy with the plan, you can return to Original Medicare anytime within the first 12 months. Then, if you dropped a Medicare Supplement plan to enroll in your Medicare Advantage plan, you can apply for the same Medicare Supplement policy you had previously if it’s still offered by the insurance company you were with before. If your former Medicare Supplement plan is no longer available, you have a special trial right to enroll in any Plan A, B, C, F, K, or L that is offered by any insurance company in your state. You may want to have your new Medicare Supplement policy go into effect at the same time your Medicare Advantage coverage ends to avoid breaks in your coverage. You can apply as early as 60 days before your Medicare Advantage coverage ends and no later than 63 days after your plan coverage ends.
You also have the right to buy certain Medicare Supplement 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 your Medicare Advantage plan’s service area.
- Your Medicare Supplement insurance company goes bankrupt or breaks the rules.
Under these circumstances, you may be eligible to buy any Medicare Supplement 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 Medicare Supplement policy.
Important note: It’s illegal for anyone to sell you a Medicare Supplement policy if he or she knows you’re in a Medicare Advantage plan, unless you’re switching back to Original Medicare.
Am I eligible for a Medicare Supplement plan if I have coverage through Medicaid?
While some beneficiaries may be eligible for both Medicare and Medicaid benefits (also known as “dual eligibles”), Medicaid typically doesn’t work with Medicare Supplement plans. You can only use your Medicare Supplement plan to pay for costs in Original Medicare.
If you’d like to keep your Original Medicare coverage, but want to see if you can get help paying 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.
- You can click the Compare Plans buttons on this page to look over plans on your own.
- Learn more about me by clicking on the “View profile” link below.
- Use the links below to schedule a phone appointment or have me email you Medicare information tailored to your needs.