Am I eligible for a Medicare supplement plan?
Medicare supplement plans only work in conjunction with original Medicare. You must have Medicare Part A and Part B to be eligible to add a Medigap policy to your coverage. In order to be eligible, you must fall in one of the following categories:
Turning 65 (Initial enrollment in Medicare)
The best time to buy supplemental insurance is within six (6) months of your initial enrollment in Plan B of Medicare. Why? Because during this time, you do not have to go through underwriting. This means, the insurance provider cannot refuse to sell you a policy, or charge you more in case you have pre-existing health issues.
Pre-existing conditions
However, you may face a waiting period for up to six months for coverage related to a pre-existing condition (“pre-existing condition waiting period”), if the condition was treated or diagnosed within six months before the coverage begins. While original Medicare will still cover expenses related to the condition (as far as it is included in the services that are covered by Medicare), you are during this time solely responsible for any co-payment or coinsurance your supplemental plan does not pay for.
You may be able to avoid or at least shorten waiting periods for pre-existing conditions, if you had a prior insurance that provided for at least six months ‘creditable coverage’ (= at least as good as Medicare).
As a supplement plan only covers one person, you and your spouse must each buy separate policies.
Eligibility of disabled persons
When you have Medicare and are under the age of 65, typically because of a disability or ESRD, depending on the regulations in your state, you may not be able to buy a Medigap policy (or not the one you may want) until you turn 65. While some states require insurance providers to also sell Medigap policies to persons on Medicare under 65 years of age, Federal law does not.
Eligibility outside the ‘Initial Enrollment Period’
If you apply for Medigap coverage after you first became eligible for Medicare, an insurance company does not have to sell you a policy if you don’t meet their medical underwriting requirements, unless you meet one of the following situations:
You have a ‘guaranteed issue right’ – this means the insurer needs to sell you a policy. This protection applies when you are eligible (you have Part A and B) and your current health care coverage changes in some way. This may, for example, be the case when you lose the other health care coverage, e.g. because the Medicare advantage or SELECT plan you had, stopped serving your area, or you moved away.
If you are denied Medigap coverage, you may contact your State Health Insurance Assistance Program (SHIP) or your State Insurance Department. You may find contact information for SHIP here.
