What is a Medicare Supplement? | Medicare Supplement Plans

Guaranteed Issue | Medigap Open Enrollment Period | Pre-Existing Conditions

There are straightforward guidelines regarding whether or not you can apply for a Medigap plan:

• You must have Original Medicare (Parts A and B).

• You must continue paying your Part B Premium

• You cannot have a Part C Medicare Advantage plan and a Medicare Supplement at the same time.  You must choose one or the other. 

If you try to purchase a Medigap outside of guaranteed issue periods (more on this below) though, determining your eligibility is a much less straightforward matter.

That is because unlike Part C (Medicare Advantage) plans, the private health insurance company operating the Medigap plan can subject you to a process called medical underwriting - asking you a series of health related questions.  That means that the company has the right to deny you coverage, charge you higher premiums than someone rated healthier, and can also subject you to coverage waiting periods if you have certain pre-existing health conditions.

Guaranteed Issue | Medigap Open Enrollment Period | Pre-Existing Conditions

A popular way to get the Medigap plan you want and avoid the medical underwriting process is to apply for a plan when you have the right of guaranteed issue. According to Medicare.gov:  

“Guaranteed issue rights (also known as ‘Medigap protections’) are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:

• Must sell you a Medigap Policy.

• Must cover all of your pre-existing conditions

• Can’t charge you more for a Medigap policy because of past or present health problems.”

How do you qualify for guaranteed issue?

There are several situations where one may qualify for guaranteed issue.  Click here for a detailed list provided by Medicare.gov. The most straightforward and popular situation though to get guaranteed issue is during your Medicare Supplement Open Enrollment Period:

Guaranteed Issue | Medigap Open Enrollment Period | Pre-Existing Conditions

If you are interested in purchasing an optional Medicare Supplement (Medigap) to cover the 20% costs that Original Medicare doesn’t, then this period is the best time to do it.  

It runs from the month your Medicare Part B is first activated and lasts for 6 months afterwards.  So, if your Part B starts on April 1, then your enrollment window lasts until September 30th (the last day of the 6th month).  

Keep in mind your Medicare Supplement Open Enrollment period only happens once in a lifetime for most people and is not an annual period.  

This period is important to understand because unlike Part C - Medicare Advantage plans, Medicare Supplement (also referred to as Medigap) plans can base your premium rate on your age and health condition, and can ask you detailed medical questions to determine your eligibility.  With Medicare Supplements (Medigap) you can be subjected to waiting periods and even be denied coverage in certain cases!   

Enrolling during your Medicare Supplement Open Enrollment period lets you avoid medical questions and denials in most cases! 

*People under 65 who receive Medicare due to disability will receive two Medicare Open Enrollment Periods.  Once when they activate their Part B under 65, and once again when they turn 65.*

Other situations that may give you guaranteed issue*

• If you move outside of your Medicare Advantage service area.

• If you move outside your Medicare SELECT (a type of Medicare Supplement that has network doctors, hospitals that serves a limited geographical area) plan service area. 

• If your Medicare Advantage plan eliminates coverage in your area or ceases operations.

• If you enroll in your first Medicare Advantage plan during your Initial Enrollment Period and are not satisfied with it, you have a 12-month trial period to return to Original Medicare and purchase a Medicare Supplement for the first time (this is a one-time right).

• If you purchased a Medigap policy, then decided to enroll in your first Medicare Advantage plan and are not satisfied, you have a 12-month trial period to return to Original Medicare and purchase your previous Medigap Plan (if the company you previously bought it through no longer offers it, you are able to buy the same plan through a different company). 

• If you have Original Medicare (Parts A and B) and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.

*There may be certain restrictions limiting which Plan letters you can purchase depending on your qualifying circumstances.

Your state may have special guaranteed issue rules*

You may also qualify for guaranteed issue depending on which state you live in:

• California and Oregon both have “birthday rules”.  These allow Medigap enrollees a 60-day window for California residents, and a 30-day window for Oregon residents, following their birthday each year when they can switch, without medical underwriting, to another Medigap plan with the same or lesser benefits.

• Connecticut, Massachusetts, and New York have guaranteed issue rights throughout the year because they have year-round Medigap Open Enrollment.

• Maine gives its residents guaranteed issue rights to enroll in Medigap Plan A during an annual one-month open enrollment period.

• Missouri allows its residents to change their Medigap policy once every year during their policy’s anniversary.  Residents are able to keep the same standardized plan but purchase it under a different health insurance carrier.

*For a more detailed and updated list, we always recommend checking with your state’s department of insurance.

Guaranteed Renewability

As long as you continue paying your premiums, your Medigap policy is guaranteed renewable and automatically renew yearly. In some states, insurance companies may refuse to renew a Medigap policy bought before 1992.

Guaranteed Issue | Medigap Open Enrollment Period | Pre-Existing Conditions

Medicare defines a pre-existing condition as a health problem you had before before the date of that new healthcare starts. 

If you do have a pre-existing condition and want to purchase a Medigap plan, we strongly recommend doing so during your Medicare Supplement Open Enrollment Period (see above).  

If you’ve missed your Medicare Supplement Open Enrollment Period, you can still attempt to purchase a Medigap plan at any time during the year but you will be likely subjected to medical underwriting - meaning the health plan will conduct a health survey on you to determine your eligibility.  

If you are not denied coverage, and you decide to purchase the Medigap policy then your plan coverage will start on the listed date.  HOWEVER, you may still be subject to a ‘pre-existing condition waiting period’ meaning that even though your coverage started right away, the health plan has the option to refuse to cover your out-of-pocket costs for the pre-existing condition for up to 6 months after you join the plan. After the 6 month period ends, the Medigap policy will cover your pre-existing condition.   

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.   

If you are subject to a pre-existing condition waiting period, it is important to remember that Original Medicare (Parts A and B) will still cover your condition even if the Medigap policy won’t.  You are still responsible for coinsurance or copayments.

Let our ‘Even Better’ Medicare plan experts answer your questions about Medigap plans, eligibility and everything else Medicare-related!  We are here for you!

Guaranteed Issue | Medigap Open Enrollment Period | Pre-Existing Conditions

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