If you are a Medicare beneficiary, you are aware of the 20% Original Medicare makes you pay out-of-pocket. One of the biggest concerns among Medicare beneficiaries is the Medicare Part B 20% coinsurance. Once you have met the annual Medicare Part B deductible (if applicable), you are responsible for the coinsurance on any medical costs accrued for the remainder of the year. This is where Medicare Supplement (Medigap) plans come into play. Below, we share everything there is to know about Medicare Supplement eligibility.
Medicare Supplement Eligibility for Beneficiaries Aging in at 65
To be eligible for a Medicare Supplement, there are a few requirements that must first be met.
Medicare Supplement Eligibility Requirements:
- Enroll in Medicare Part A and Medicare Part B
- Be a citizen or legal resident of the United States for at least five years
- Reside in the state offering the Medicare Supplement plan at time of application
- Undergo medical underwriting if outside of Open Enrollment or Special Enrollment Period (in most states)
Once you acquire Original Medicare, you can use your Medicare Supplement Open Enrollment Period to enroll in the Medicare Supplement policy of your choice.
When you enroll during this enrollment period, you do not need to go through medical underwriting. This means any pre-existing health conditions or health history will not impact your admittance to a Medicare Supplement policy. For most beneficiaries, this only happens once in their lifetime and lasts for six months.
When you first enroll in Original Medicare, you have the best opportunity when it comes to Medicare Supplement eligibility. Although you may enroll in a Medicare Supplement plan at any time once you become eligible, the six months after your Medicare Part B enrollment is the best time to enroll with guaranteed acceptance. Every beneficiary has the opportunity to take advantage of top-quality coverage at the lowest price when turning 65.
Medicare Supplement Eligibility for Beneficiaries Under 65
Medicare Beneficiaries under 65 do not have as many Medicare Supplement choices. Not all states offer Medigap plans to those under 65. However, a handful of states require Medicare Supplement plan carriers offer at least one policy to those under 65.
Often, the only option for those under age 65 is Medicare Supplement Plan A. Still, each state is different, so it is important to speak with an agent to understand all options available to you.
Insurance companies know that Medicare beneficiaries under 65 are likely on Social Security Disability. Those with qualifying disabilities pose a higher risk for claims because they require more consistent care. So, the cost of a Medicare Supplement plan is usually higher for people under 65.
The upside to obtaining Medicare Supplement eligibility before age 65 is that you will be eligible for two Medicare Supplement Open Enrollment Periods. Due to the limited number of Medicare Supplement plan options when you are under 65, you are given a second opportunity to enroll in Medicare Supplement coverage for six months following your 65th birthday.
Even if you become eligible for a Medicare Supplement plan under 65, you should plan to purchase a Medicare Supplement plan at 65. Doing so will provide peace of mind and protect your savings from astronomical health care expenses.
Medicare Supplement Enrollment Periods
Once you are eligible for a Medicare Supplement plan, your eligibility does not go away. If you have Medicare Part A and Part B, you can apply for a Medicare Supplement plan at any time. However, that does guarantee admission to the plan.
Under certain circumstances, it is possible to apply for a Medicare Supplement plan and avoid a health screening or waiting period outside of your Medicare Supplement Open Enrollment Period. This is known as a guaranteed issue period.
These are several circumstances that allow a beneficiary to enroll in a Medigap plan using a guaranteed issue rights. The most common is if you have employer-sponsored coverage secondary to Medicare, and that policy ends. In this case, you will be eligible to reap the benefits of a Special Enrollment Period and guaranteed issue rights.
How to Get Help Understanding Your Medigap Eligibility
Medigap eligibility is confusing; thankfully there are licensed agents and Medicare experts to help you understand the most recent information regarding your eligibility.
Whether you are new to Medicare, or a seasoned pro, our licensed agents can answer all your questions and walk you through the application process.
At MedicareFAQ, we pride ourselves on putting education first. With the proper knowledge, you can make the best possible decision for your needs. No one knows what works best for you better than you, and we know how to use that information to find the best policy.
To compare rates side-by-side, call one of our licensed Medicare experts at the phone number above or fill out our online rate form.