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Medigap Eligibility in 2021

Let’s start with the basics of Medigap eligibility requirements. To qualify for a Medicare Supplement plan, you must be enrolled in Medicare Part A and Part B.

Also, you must either be a United States citizen or legal resident who has been in the U.S. for at least 5 consecutive years to enroll in a Medigap plan.

Who is eligible for Medicare Supplement Insurance?

Most people become eligible for Medigap when they turn 65 and enroll in Medicare. However, this isn’t the only way to qualify for Medicare Supplement Insurance.

Medigap Eligibility for Those 65 and Older

The most common time for most people to sign up for Medigap insurance is when they turn 65 and first become eligible for Medicare. Your Medigap Open Enrollment Period (OEP) begins the first day of the month you turn 65 and are enrolled in Part B. This period lasts for six months, and during this time, you are permitted to enroll in any Medicare Supplement plan without having to undergo medical underwriting. 

If you choose to wait to enroll until after your OEP finalizes, insurance companies in most states won’t be obligated to sell you a policy and can even reject you based on your health history.

Medigap Eligibility for Those Under 65

Federal law does not require insurance companies to sell Medigap policies to individuals under the age of 65. Therefore, if you qualify for Medicare because of disability benefits, you may not be able to sign up for a Medicare Supplement plan

For example, only 28 states offer Medigap coverage to people with End-Stage Renal Disease on dialysis. Many states offer at least one kind of Medigap plan to Medicare beneficiaries under 65

You should know that beneficiaries that qualify for Medicare because of a  disability who choose to enroll in Medicare Supplement Insurance typically face higher monthly premiums. However, Medigap premiums are regulated in some states to keep them low for these individuals.

Guaranteed Issue Rights

Also called “Medigap protections”, guaranteed issue rights are granted in certain situations to protect your right to a Medigap policy

Guaranteed issue rights state that an insurance company must sell you a Medigap policy which covers all of your pre-existing health conditions. 

Additionally, they protect you against being charged more for your Medigap policy as a result of your past or present health conditions.

When are guaranteed issue rights granted?

Some of the situations in which guaranteed issue rights apply include when: 

  • You’re enrolled in a Medicare Advantage plan and your plan is leaving Medicare or ending coverage in your geographic area
  • You you move out of your Medicare Advantage plan’s service area
  • You have Original Medicare and health care coverage under your employer and that policy is ending
  • You are enrolled in a Medicare SELECT policy and you are moving out of the plan’s service area
  • Your Medigap insurance company goes bankrupt and you lose coverage
  • You have left a Medicare Advantage plan or Medigap policy because the company broke the rules or misled you

Another situation in which guaranteed issue rights apply is in “trial rights” circumstances. This occurs when: 

  • You joined a Medicare Advantage plan or PACE (Programs of All-inclusive Care for the Elderly) program when you first became eligible for Medicare at age 65 and you decide you want to switch to Original Medicare within the first year of joining
  • You left your Medigap plan to switch to a Medicare Advantage Plan or Medicare SELECT policy for the first time and you want to switch back (and you have been enrolled in the Medicare Advantage or SELECT plan for less than a year). 

As you can see, guaranteed issue rights can protect you from being denied Medigap coverage in a variety of situations. But they don’t apply in every person’s case. If you are interested in signing up for a Medigap policy, it is usually advisable that you do so during your OEP if possible

Choosing a Medicare Supplement plan can be overwhelming, and you shouldn’t have to figure it out on your own. Reach out today to receive Medigap advice from an experienced insurance agent here at Medicare Plans Direct.

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