Medicare Supplement insurance offers more flexibility regarding enrollment periods compared to other Medicare plans. As long as you are enrolled in Original Medicare, Part A and Part B, you have the option to apply for a Medicare Supplement insurance plan at any time. However, there’s a catch when it comes to approval, especially if you have a pre-existing condition.
Certain insurance companies selling Medicare Supplement (Medigap) insurance can refuse coverage or charge higher premiums based on your health condition. There is a crucial exception, though. During your Medigap Open Enrollment Period, you have guaranteed-issue rights, allowing you to purchase a Medicare Supplement insurance plan without facing these restrictions, as explained further below.
When can I purchase a Medicare Supplement insurance plan with guaranteed-issue rights?
Typically, the ideal time to secure a Medicare Supplement insurance plan is during your Medigap Open Enrollment Period (OEP), which spans six months and commences on the first day of the month in which you turn 65 and are enrolled in Medicare Part B.
For instance, if your birthdate is August 31, 1958, and you turn 65 in 2023, assuming you are automatically enrolled in Medicare Part A and Part B, your Medicare coverage would begin on August 1, 2023. In this example, the first day of the month you meet both criteria—being 65 or older and enrolled in Medicare Part B—is August 1, 2023. Your Medigap OEP would extend until January 31, 2024.
The significance of the OEP lies in the fact that it grants you guaranteed-issue rights to purchase a Medicare Supplement (Medigap) insurance plan. During this period, insurance companies cannot utilize medical underwriting, which assesses your health conditions and associated coverage costs.
What are the rules for enrolling in a Medicare Supplement insurance plan?
First and foremost, you must be enrolled in Original Medicare (Medicare Part A and Part B). Additionally, it’s important to note that Medigap insurance plans are incompatible with Medicare Advantage plans. If you have a Medicare Advantage plan and wish to switch to Medigap, you must first discontinue your Medicare Advantage plan and revert to Original Medicare. Outside your guaranteed-issue rights period, insurance companies may reject your application or charge higher premiums based on your health status.
However, during your OEP, you have the assurance of guaranteed-issue rights. This means you can be accepted into a Medicare Supplement insurance plan regardless of your health condition. If you apply for a Medicare Supplement insurance plan after your OEP concludes, in most cases, you lose your guaranteed-issue rights. Insurance companies might decline your application or impose higher costs based on your health history.
How can I enroll in a Medicare Supplement plan if I’m under 65?
Federal regulations do not mandate insurance companies to offer Medigap plans to individuals below the age of 65. If you are under 65 and enrolled in Medicare, it’s advisable to check whether insurance providers in your state extend Medigap plans to Medicare beneficiaries in your specific situation. Not every state obliges insurance companies to sell Medigap policies to those under 65.
For individuals under 65, it is recommended to consult your state insurance department or your state’s SHIP program for specific guidelines.
Are there other opportunities to enroll in a Medicare Supplement plan?
If you are outside your Medigap Open Enrollment Period, there could still be options to acquire a Medigap plan. If you have a pre-existing health condition, your chances are higher if you have guaranteed-issue rights. Below are some situations that could grant you guaranteed-issue rights, apart from your OEP (not an exhaustive list):
- You discontinued your Medicare Supplement plan to exercise your trial right for a Medicare Advantage plan. If less than a year has elapsed and you wish to return to Original Medicare, you have this option.
- Your Medicare Advantage plan ceases to provide services in your area, prompting your return to Original Medicare.
- You relocate outside your Medicare Advantage plan’s coverage area, necessitating your return to Original Medicare.
- Your Medicare Supplement plan engaged in fraudulent activities or misled you.
- Your Medicare Supplement plan declared bankruptcy.
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