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Medigap Eligibility

Your Guide to Medicare Supplement Eligibility

Medicare supplement insurance plans sold by private insurance companies require individuals to be legal U.S. citizens or permanent residents for a minimum of five consecutive years. They must also already be enrolled in Parts A and B. Most states require individuals to be 65 or older, but there are some insurance carriers that offer plans to Medicare beneficiaries who are younger than 65.Supplement plans are standardized by the federal government. Standardization means that each plan, which is differentiated by a letter of the alphabet, is consistent across different insurance carriers. No matter which insurance company offers the plan, each Medigap plan remains the same. Since they are standardized, once you determine you are eligible it is important to compare premiums and health plan options among different carriers so you don’t have to pay more for the same coverage.It is not possible to be enrolled in a Medicare Advantage (Part C) plan and buy a Medigap plan at the same time. The only exception can imply a situation where you’ve joined a Part C plan for the first time and wish to disenroll. In that case, you have a 1-year time period, also known as the trial right period, to join Original Medicare and buy a Medigap plan. Keep in mind Medigap policies cover only one person, so if you wish to insure your whole family, for example, you should think about researching family health plan options.

Medigap Eligibility at Age 65

Enrollment periods are time periods during which you can enroll in a Medigap plan of your choice. Adults who are already receiving Social Security benefits will be automatically enrolled In Medicare Part A upon turning 65. In some cases, this applies to Medicare Part B as well. Once you are enrolled in both parts, your unique open enrollment period for Medicare supplements begins and you can research coverage options to get the plan that best meets your needs.

When you enroll during this period of time, you have guaranteed issue rights to any Medicare supplement plan. You can not be turned away from a plan due to any health conditions or health history reports. The open enrollment period ends six months after your Part B effective date.

Medigap Eligibility Under Age 65

Medicare beneficiaries who do not meet the eligibility requirements age-wise still have a chance to enroll in Medigap but with more difficulty. Individuals who are not yet 65 do not have as many options when it comes to Medicare supplements. Some carriers offer plans in some states, but it is usually limited to Plan A, the most basic Medigap plan.

The reason for the lack of choice is that Medicare beneficiaries who are younger than 65 are on Medicare because of a disability. This means that they have higher healthcare costs and are at a higher risk for claims. This also means that the monthly premiums for Plan A are double or triple the amount that someone over 65 would pay. (This is not the case in every state.)

Individuals who hold a Medigap policy under 65 will have the opportunity to choose a new plan when they turn 65. At this time, they will still have guaranteed issue rights.

Understanding Your


There are many factors that go into your unique eligibility for Medicare supplements. Luckily, we’ve got some knowledgeable agents that can get to know your circumstances and help you figure out what enrollment periods you are eligible for.

Opportunities for Guaranteed Issue Rights

There are times outside of an individual’s open enrollment period that they may still have guaranteed issue rights, meaning that they do not have to pass medical underwriting to be admitted to a policy. These times are called Special Enrollment Period (SEP).

You are eligible for a SEP if you have a group health policy, or employer coverage, through your (or your spouse’s) employer that will be ending. You are also granted a SEP if your current plan carrier commits fraud, misleads you into enrollment, loses your Medicare contract, or fails to meet the contractual guidelines outlined by the Medicare program.

Lastly, you are also eligible for a SEP if you are currently enrolled in a Medicare Advantage plan that has increased the copayments or premiums by 15% or more, has discontinued your plan, has reduced your benefits, or has ended their contact with your provider.

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