When can I buy Medigap? (Important)

Buy a policy when you’re first eligible 

When can I buy Medigap? The best time to purchase a Medigap policy is during the 6-month open enrollment period of Medigap. In general, you get better prices and more choices among policies. During this time, you can purchase any Medigap policies sold in your state, even if you have health problems. This period automatically starts the first month you have Medicare Insurance Part B (Medical Insurance) and you are 65 years old or older. It can’t be changed or repeated. You may not be able to purchase a Medigap policy after this enrollment period. If you can buy one, it can cost more due to past or current health problems. 

During open enrollment 

Generally, Medigap insurance companies can use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap insurance policy. But even if you have health problems, you can purchase any insurance policy sold by the company at the same price as people in good health during your Medigap opening enrollment period. 

Read More: Costs of Medigap policies

Find your situation below:

I’m 65 years old or older.

 The Medigap Open enrollment period starts when you sign up for Part B and can’t be changed or repeated. In most cases, it makes sense to enroll in Part B when you are qualified for the first time, otherwise, you will have to pay a late enrollment penalty in Part B. 

I’m turning 65.

The best time to purchase a Medigap insurance policy is the 6-month period that starts on the first day of the month when you are 65 or older and enrolled in Part B. For example, if you are 65 years old and enrolled in Part B in June, the best time to purchase a Medigap policy is June to November. After this enrollment period, your option to purchase a Medigap insurance policy may be limited and may cost more. Some states have additional open enrollment deadlines. 

I’m under 65.

Federal law does not require insurance companies to sell Medigap insurance policies to people under the age of 65. If you are under 65 years old, you may not be able to purchase the Medigap insurance policy or a Medigap policy that you want until you are 65 years old. However, some states require Medigap insurance companies to sell you a Medigap policy even if you are under 65 years old. If you can purchase one, it can cost you more. 

I have group health insurance coverage through an employer or union.

If you have health insurance through an employer or union because you or your spouse are currently working, you may want to wait until you enroll in Part B. Employer plans usually offer coverage similar to Medigap, so you don’t need a Medigap insurance policy.

When your employer’s insurance ends, you have the option to enroll in Part B without a late enrollment penalty. This means that the Medigap open enrollment deadline starts when you’re ready to use it. If you enrolled in Part B while still having employer insurance, you would begin your open Medigap enrollment period. Unless you bought a Medigap policy before you needed it, you would completely lose your open enrollment period. 

Read More: Medicare Supplement Plan B

Outside open enrollment

If you apply for Medigap insurance coverage after the open enrollment period, there is no guarantee that an insurance company will sell you a Medigap policy if you do not meet underwriting requirements, unless you are eligible due to one of the situations listed below.

In some states, you may be able to purchase a different type of Medigap insurance policy called Medicare SELECT. When you purchase a Medicare SELECT policy, you are entitled to change your mind within 12 months and switch to a standard Medigap policy. 

I’m under 65 and am eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD).

If you have ESRD, you may not be able to purchase the Medigap policy you want until you are 65 years old. Federal law does not require insurance companies to sell Medigap insurance policies to people under the age of 65. 

Note: A Medigap insurance policy is not available for people with ESRD under 65 years of age. 

Note: Some states grant these rights to anyone with Medicare under the age of 65. Other states grant these rights only to people who are eligible for Medicare due to a disability, or only to people with ESRD. Check with your state insurance department what rights you might have under state law. 

I have health problems.

An insurance company cannot use the medical underwriting during the Medigap open enrollment period. This means that the company cannot do any of these things because of your health problems:

• Refuse to sell you any Medigap policy it sells
• Make you wait for coverage to start (except as described below) 
• Charge you more for a Medigap policy. 

In some cases, an insurance company may need to sell you a Medigap insurance policy even if you have health problems. You are guaranteed the right to purchase a Medigap policy:

•  If you are in your Medigap open enrollment period
•  If you have a guaranteed issue right

you can also purchase a Medigap policy at other times, but the insurance company can deny you a Medigap policy based on your health.

Read More: Medicare Supplement Plan A – Medigap Plan A Rates for 2020

I have a pre-existing condition

The insurance company cannot keep you waiting for your coverage to begin but can keep you waiting for coverage if you have a pre-existing condition.

In some cases, the Medigap insurance company may refuse to cover out-of-pocket costs for these pre-existing health problems for up to 6 months (called the “pre-existing condition waiting period”). After these 6 months, the Medigap policy will cover your pre-existing condition.

Coverage for the existing disease may be excluded if the condition has been treated or diagnosed within 6 months prior to the start of coverage under the Medigap insurance policy. After these 6 months, Medigap’s policy covers the excluded condition. 

When you receive Medicare-covered services, Original Medicare continues to cover the condition, even if Medigap’s policy doesn’t cover your out-of-pocket costs, but you are responsible for coinsurance or copayment. 

have a pre-existing condition and am replacing “creditable coverage.”

You can avoid or shorten waiting times for a pre-existing condition if you purchase a Medigap insurance policy during your Medigap Open enrollment period to replace “creditable coverage (Medigap)”. If you’ve had continuous prior creditable insurance coverage for at least 6 months, the insurance company Medigap can’t keep you waiting before it covers your pre-existing condition. Many types of health care can be considered creditable coverage for Medigap insurance policies, but they only count if your break in coverage was no more than 63 days.

I have other insurance.

 If you have group health insurance through an employer or union, your open enrollment period for Medigap begins when you enroll in Part B. 

I have a guaranteed issue right.

If you purchase a Medigap policy when you have a guaranteed issue right (also called “Medigap protections”), the insurance company cannot use a pre-existing condition waiting period.

Can I enroll in a Medicare Supplement plan at any time?

An interesting feature of insurance plans for the Medicare Supplement is that you can apply for a plan anytime; you just need to be enrolled in Medicare Part A and Part B. However, a plan doesn’t have to accept your application unless you have guaranteed allowances. 

At what age can you get Medigap insurance?

If you are under 65 years old, you may not be able to buy the Medigap insurance policy or the policy you want until you are 65 years old. However, some states require Medigap insurance companies to sell you a Medigap insurance policy even if you are under 65 years old. 

Who is eligible for Medigap plans?

In most states, you must be 65 years of age or older, but insurance companies in some states offer at least one Medicare supplement to Medicare beneficiaries under 65. Anyone who is at least 65 years old and enrolled in Medicare Parts A & B is entitled to Medigap.