Medigap Eligibility

Did you know that insurance companies must sell you a Medigap (Medicare Supplement) plan during specific periods of time? The two time periods are known as "open enrollment" and the other times are called "guaranteed Issue periods".

Insurance companies may decline to sell you an insurance policy during any other time. If you had or have a current health issue, you might not be able to buy the Medigap plan that you want.

Open Enrollment - If you are a senior citizen, Medigap companies must sell you an insurance policy. Whether or not you have health problems and you are at least 65 years of age and apply within six months after enrolling in Medicare Part B.

This time period of six months is your open enrollment period. During your open enrollment period, an insurance company must allow you to purchase any one of the Medigap plan it offers.

You can also use your open enrollment rights at any time during that six month period to cancel or change to a Medigap plan that better meets your needs.

Remember that even though a company must sell you a Medigap policy during open enrollment, they can require a six month waiting period before covering any of your pre-exisiting conditions. Pre-exisiting conditions are medical condtions that you got treatment for or got advice from a medical professional within the previous six months.

Even if you wait for several years to enroll in Medicare Part B after you turn 65, you are still entitled to the open enrollment period.

Do you have a disability? If you are under the age of 65 and receive Medicare due to a disability, you have a six month open enrollment period that starts the day you enroll in Mediare Part B. This open enrollment period only applies to Medigap Plan A.

Insurance companies that sell Medicare supplement insurance in a certain state may not deny selling you a Medigap Plan A policy because you have a pre-exisiting condition. Companies are not required to offer you any other Medigap plans, but they can if they want to.

Once you turn 65, during the first six months and are enrolled in Medicare Part B, you have the right to buy any of the 12 Medigap plans.

Guaranteed Issue - You might be able to purchase a Medigap policy outside of your open enrollment period if you lose some types of health coverage. If you are over the age of 65, you have the guaranteed issue right to Medigap Plans A, B, C, F, K, and L. If you are under the age of 65, this guaranteed issue right only applies to Medigap Plan A.

In most cases, this guaranteed issue right is for 63 days from when your coverage ends or from the date you received notice that your coverage would end. Insurance companies can not place any exclusions or pre-exisiting conditions on these policies. Again, this is known as guaranteed issue. You must provide proof that you lost your health care coverage.

This guaranteed issue right is also for people on Medicare that have lost Medicaid coverage because of a change in their financial status.

Guaranteed Issue and disenrollment in Medicare Advantage - What you might not know about Medicare Advantage Plans is that they have the right to terminate their contract with Medicare in any service area that they want. If this happens to you, it means you will no longer be covered by your plan and you will be placed back on Medicare at the beginning of the next year.

If your Medicare Advantage Plan does terminate its Medicare contract in your service area, you can purchase any Medigap Plan A, B, C F, K, or L that is offered in your state. This is regardless of you medical condition or medical history. If your Medicare Advantage coverage ends in your service area, they must explain to you in writing your options for buying a Medigap policy.

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