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Medigap Eligibility

Your Guide to Medicare Supplement Eligibility

To be eligible for Medicare supplement insurance plans, individuals must be legal U.S. citizens or permanent residents for at least five consecutive years and enrolled in Parts A and B. Although most states require individuals to be 65 or older, some insurance carriers offer plans to those under 65. These plans are standardized by the federal government, meaning that each plan is consistent across different insurance carriers, even though the prices may differ. Medicare beneficiaries cannot be enrolled in a Medicare Advantage (Part C) plan and a Medigap plan at the same time, with the exception of the trial right period. During this one-year period, beneficiaries who disenroll from a Part C plan can join Original Medicare and purchase a Medigap plan. Medigap policies cover only one person, so families should research family health plan options for coverage of multiple individuals.

Medigap Eligibility at Age 65

Enrollment periods are specific time frames during which individuals can enroll in a Medigap plan of their choice. If you are already receiving Social Security benefits, you will be automatically enrolled in Medicare Part A when you turn 65, and in some cases, this also applies to Medicare Part B. Once you are enrolled in both parts, your unique open enrollment period for Medicare supplements begins, during which you can research coverage options and choose the plan that best meets your needs. During this period, you have guaranteed issue rights to any Medigap plan, which means you cannot be turned away due to any health conditions or health history reports. The open enrollment period typically lasts for six months after your Part B effective date.

Medigap Eligibility Under Age 65

Medicare beneficiaries who are under 65 years old and not yet eligible for Medicare due to age can still enroll in a Medigap plan, but with more limited options. Usually, only the basic Plan A is available in most states. This is because those under 65 are on Medicare due to a disability, and this group is considered to have higher healthcare costs and claims risk. Therefore, premiums for Medigap Plan A for those under 65 can be double or triple the amount of those over 65. However, there are some states where this is not the case. When individuals with a Medigap policy under 65 turn 65, they will have the opportunity to choose a new plan with guaranteed issue rights.

Understanding Your Medicare Supplement Eligibility

Determining eligibility for Medicare supplements can be complicated due to the various factors involved. However, our experienced agents can help you understand your circumstances and identify the enrollment periods for which you are eligible.

Opportunities for Guaranteed Issue Rights

During certain periods outside an individual’s open enrollment period, they may have guaranteed issue rights, which means that they don’t need to go through medical underwriting to be accepted into a policy. These periods are known as Special Enrollment Periods (SEPs).

If you have group health coverage or employer coverage through your own or your spouse’s employer that will end, you’re eligible for a SEP. You’re also granted a SEP if your current plan carrier engages in fraud, deceives you during enrollment, loses their Medicare contract, or fails to meet contractual guidelines set out by the Medicare program.

Furthermore, if you’re currently enrolled in a Medicare Advantage plan that has increased copayments or premiums by 15% or more, has discontinued your plan, has reduced your benefits, or has ended their contract with your provider, you’re eligible for a SEP.

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