Am I Eligible for a Medicare Supplement Plan?
You are eligible for any Medicare Supplement plan (Medigap) if you are already a member of Original Medicare enrolled in both Part A and Part B. You can apply for a Medigap plan of your choosing during the six-month Open Enrollment period, which is a government-mandated and one-time-only window given to new members to avail of any policy in his or her state.
The six-month Open Enrollment period starts in the first month that you gain Medicare Part B coverage AND you are already 65 years or older. During this time, insurance providers are required to approved any policy you apply for. They cannot deny your application or charge you higher fees because of past or current health problems.
However, if you apply beyond the Open Enrollment period, you might be asked to produce a health statement to prove wellness. The insurance provider now can also deny your application, subject you to medical underwriting, or charge you higher premium fees.
What If You’re Under 65 Years Old?
If you are not 65 years old yet but are enrolled in Medicare due to a disability or End Stage Renal Disease (ESRD), you will also be given a six-month period to apply for any Medigap policy without any medical underwriting. But, in general, because such special Medicare beneficiaries have higher healthcare costs, most Medigap providers tend to shy away from offering coverage to people under the age of 65—unless the state requires them to do so.
Government regulations that apply to Medicare Supplement Open Enrollment typically do not extend to people who are not senior citizens. Some states will allow you to purchase a Medigap plan before you turn 65, as long as you are already enrolled in Medicare Part A and Part B. Some 31 U.S. states do allow insurers to sell at least one type of Medigap coverage to such special cases, though it’s always better to ask first and not make any assumptions.
If this is your case, find out if your state has any provision that requires Medigap provides to extend accommodation to people under the age of 65. Or you can talk to our qualified Medicare Supplement advisors to determine your best options for healthcare coverage.
Can You Be Denied Medicare Supplement Coverage?
It is possible to be denied from a Medigap insurance plan. Either the insurance provider turns your application down or decides to charge you a higher premium fee. Such cases include:
Having Medicare but are below 65 years old
Being 65 years old but are still not enrolled in Original Medicare Part B
Having a health problem and the Open Enrollment period has expired
Note that the definition of a pre-existing health condition varies per insurer, so check with your preferred provider to find out the specific list of illnesses that are included.
Guaranteed Issue Rights
Guaranteed issue rights are rights that you have in specific situations, during which the insurance provider is required to offer you certain Medicare Supplement plans outside of your Open Enrollment period. An example is when you have another type of healthcare coverage that changes along the way through no fault of yours, like when your original insurance provider suddenly shuts down and you are left with zero coverage.
Other situations that may apply to guaranteed issue rights include:
- Having Original Medicare plus a Medicare SELECT plan and you moved out of the SELECT plan’s service area
- When you drop a Medigap plan to join a Medicare Advantage plan (or switching to SELECT) for the first time and you want to switch back (and you’ve only been in the plan for less than 12 months)
- When your Medigap insurer goes bankrupt
- When you have Original Medicare and you union coverage or work group health policy (such as COBRA or retiree) coverage is about to end
During such situation, insurers are required to sell you a Medigap plan and cover all your current health conditions. They also cannot charge a higher fee regardless of your past or present health status.
