Medicare Beneficiaries that meet certain criteria have Medigap eligibility. This includes having both Medicare Part A as well as Part B.
Medigap eligibility also requires applicants to be United States citizens or permanent legal residents for at least 5 consecutive years. In most states you need to be 65 years or older; however, insurance carriers in a few states offer at least one Medicare Supplement to Medicare beneficiaries under 65 years.
Medigap Eligibility for Beneficiaries Turning 65
Once you’ve acquired Original Medicare, you can use your Medicare Supplement Open Enrollment Period (OEP) to select a Medicare Supplement policy.
The best part, when you enroll during this period, there’s no medical underwriting and you qualify for Guaranteed Issue Rights. This only happens once in a beneficiary’s lifetime and lasts for 6 months.
Those new to Medicare have the best opportunity when it comes to Medigap eligibility. Taking advantage of top-quality coverage at the lowest price is the opportunity every beneficiary has when turning 65.
Medicare Supplement Eligibility for Beneficiaries Under 65
Medicare Beneficiaries under 65 don’t have as many Medigap choices. Insurance companies in some states offer beneficiaries under 65 at least one policy.
The policy that is usually available to Medicare beneficiaries under 65 is Medigap Plan A.
Insurance companies know that beneficiaries under 65, receiving Medicare are likely on disability. Those on disability are a higher risk for claims because they need more consistent care. So, the cost of a supplement is usually higher for people under 65.
Those receiving Medicare under 65 should plan to purchase a Medigap plan at 65; this will provide peace of mind and protect your savings from astronomical healthcare expenses.
Medigap Eligibility for Beneficiaries Over 65
Waiting to purchase a policy outside of the Medigap Open Enrollment Period could mean coverage denial or a higher premium. Although, many seniors have sent in an application for coverage outside the Medicare Supplement eligibility period and had successful policy placement.
Beneficiaries over 65 should work with a Medicare expert to ensure their application is sent to the company most likely to approve coverage. Contact one of our agents at the number above.
Pre-existing Conditions and Medigap Insurance
California allows beneficiaries the birthday rule; change plans with the same or fewer benefits within 30 days after each birthday.
Beneficiaries that enrolled in a Medicare Advantage plan at age 65 can change their mind within the first 12 months and sign up for Medigap with Guaranteed Issue rights.
Also, Medicare Advantage beneficiaries that move out of their plans service area can sign up for Medigap, with no worries of policy denial because of a pre-existing condition.
However, supplement insurance companies can refuse to cover prior health issues for the first 6 months. This is called the Medicare Supplement pre-existing conditions waiting period”. During this period, Original Medicare will pay their portion of covered services.
Each insurance company offers its own underwriting guidelines, an insurance expert is educated on which companies are most likely to approve certain applications.
Beneficiaries with pre-existing conditions need an insurance broker to identify the most suitable policy and company for their needs.
Denied Medigap Coverage
Outside of the Medicare Supplement OEP, Medicare beneficiaries can see denial for Medigap coverage because of health status. Those with End-Stage Renal Disease (ESRD), likely won’t find a supplement policy before 65.
However, Medigap Eligibility varies by state; therefore, working with an insurance agent in your state is beneficial.
Those that receive coverage denial for Medigap because of medical issues can find a Medicare Advantage Special Needs Plan (SNP) in your area designed for your conditions.
For Example, if you have ESRD; then in some areas there is an SNP designed just for people like you in your region.
Medigap Eligibility Period
Yes, it’s possible to apply for a supplement plan and avoid a health screening or waiting period. This is known as a Special Election Period.
If you have an employer-sponsored supplement secondary to Medicare, and that policy ends; you’ll reap the benefits of Guaranteed Issue rights.
When a Medicare Insurance company commits fraud, loses the Medicare contract, mislead you to enroll, or doesn’t meet the Medicare contractual guidelines then find a supplement company with Guaranteed Issue rights.
Medicare Advantage plan beneficiaries can switch to Medigap if they increased the copayments or premium by 15 percent or more, stopped offering the plan, ends its relationship with your provider, or reduced benefits.
Medigap Eligibility Questions
Who is eligible for Medigap?
Anyone who is at least 65 years old and enrolled in Medicare Parts A & B. You must also be an American citizen or a permanent legal resident for a minimum of 5 years.
Can you buy a Medigap policy at any time?
Yes, but you may have to go through medical underwriting during the application process if you’re not in your Initial Enrollment Period and/or don’t have Guaranteed Issue.
Can I be denied coverage?
If you’re in your Initial Enrollment Period and/or have Guaranteed Issue, you cannot be denied coverage. If you’re outside an enrollment period, you may have to answer some medical underwriting questions.
Is Medigap worth the cost?
Yes, since Medicare comes with lots of out of pocket costs, including only covering 20% of your medical costs, Medigap plans are worth the cost.
Agents Understand Medigap Eligibility
Medigap eligibility is confusing; thankfully there are brokers that can help you understand the most recent information regarding your eligibility.
Whether you’re new to Medicare, over 70 with Medicare, or under 65; our insurance brokers can answer all your questions and walk you through the application.
MedicareFAQ works hard to make Medicare easier for beneficiaries to understand. To compare rates side by side call one of our licensed Medicare experts at the number above or fill out the online rate form.