Original Medicare is a great benefit for older Americans to receive. But as good as it is, Medicare won’t cover everything. That’s why it’s important to know how to apply for a Medigap plan if you decide you need one.

While it’s not an overly complicated process, increasing your knowledge about how Medigap works and what your options are will boost the likelihood that you get a plan that fits your life perfectly.

How to Apply for A Medicare Supplement Plan

Medicare Supplements, also known as Medigap, are insurance coverages from private insurance companies that assist in covering your portion of the Medicare cost-share.

Once you are receiving Medicare benefits, you can enroll at any time after that. Since the plans are provided by private companies, you can’t simply go online and enroll yourself. You’ll need to work with a licensed insurance agent.

When to Apply for Medicare Supplement

Open Enrollment

If you start Medicare, your open enrollment period is the best to apply. In most cases, your open enrollment begins 6 months before your 65th birthday or Part B start date. It continues for 6 months after your Medicare Part B starts.

Suppose you have a qualifying illness or disability that qualifies you for Medicare before 65. In that case, you will get a second open enrollment as you approach your 65th birthday.

When you are in your open enrollment, you can choose any plan you want. You’re not required to undergo medical underwriting.

What if I miss Medicare Open Enrollment?

You can still add a Medigap plan if you miss open enrollment. You must be healthy enough to qualify and you can enroll in a Medicare Supplement anytime.

Keep in mind some carriers may not accept you or give you a higher rate based on your health outside of your open enrollment.

Guaranteed Issue Rights for Medigap Plans

Guaranteed Issue Rights in Medicare supplement insurance can be confusing. There are seven guaranteed issue rights in which you can get a Medicare Supplement without having to medically qualify. Not all plans are available as a guaranteed issue.

The seven guaranteed issue rights for Medicare supplement insurance are as follows:

Loss of Medicare Advantage coverage area

Suppose you are enrolled in a Medicare Advantage plan. In that case, you move out of the coverage area, or the plan stops offering coverage in your area.

Moving out of a Medicare Supplement Select coverage area

Suppose you are currently insured by a Medigap Select plan. In that case, you move out of the coverage area, or the plan stops offering coverage in your area.

  • Mislead – You were misled by your agent.
  • Bankrupt – Your current Medigap company becomes insolvent.
  • Involuntary loss of group employer coverage – You are losing your group employer coverage of no fault of your own.
  • Trial-Right 1 – You start Medicare and elect a Medicare Advantage plan. Within 12 months of the plan, you decide to return to Original Medicare.
  • Trial-Right 2 – Suppose you have been on Medigap plan the entire time on Medicare. You decide to try a Medicare Advantage plan. Within 12 months of being on the Medicare Advantage plan, you decide you don’t like it and want to return to Original Medicare.

You can select only specific plans using your guaranteed issue right in most of these circumstances. The exceptions are the trial-right options.

Trial-right 1 allows you to choose any Medigap plan you would like with any carrier.

Trial-right 2 requires you to return to the company and plan before trying the Medicare Advantage plan. Suppose that company is no longer in business or no longer offering that plan. In that case, you can choose any plan with any carrier.

Can I Still Enroll If I Don’t Have A Guaranteed Issue Situation?

Yes, you can always enroll in a Medigap plan. It can get tricky if you are currently enrolled in a Medicare Advantage. Remember that you will need to pass medical underwriting to enroll in a Medicare Supplement outside of Open Enrollment or a Guaranteed Issue situation.

Pre-Existing Conditions

Some carriers have pre-existing clauses, which means they could approve you for the plan, but have a waiting period for conditions you are already diagnosed with. CMS recently proposed a rule to change the waiting period conditions.

What reasons can I be denied coverage?

There are many medical reasons for which you could be denied coverage. Chronic conditions such as Hepatitis C, Dementia, and Alzheimer’s will always decline you for coverage. Every carrier has slightly different underwriting, so you will need to speak to an agent that can access the health questions and declinable medications list.

FAQs

When can I switch to a Medigap plan?

You can switch to a Medigap plan anytime, but you may be subject to Medical underwriting.

Suppose you are on a Medicare Advantage plan. In that case, unless you have an enrollment period to drop the MA plan, you may have to wait until the Annual Enrollment Period or the Medicare Advantage Open Enrollment Period.

A licensed agent should guide you on if you have a way to drop the Medicare Advantage plan.

Can I change my Medicare Supplement plans every year?

You can if you choose, but it is not necessary.

Does a Medicare Supplement plan increase yearly?

Most of the time, you will see a rate increase annually.

Can my Medicare Supplement drop me because of my claims?

No, Medicare supplements are guaranteed renewable. This means they cannot drop you as long as you pay your plan premiums.

Can I be denied for pre-existing conditions?

Yes and No. If you are in Open Enrollment or a Guaranteed Issue situation, you cannot be denied for pre-existing conditions.

What health conditions can lead to denial of coverage?

Some declinable conditions include Alzheimer’s disease, dementia, diabetes with complications, heart disease and complications, the usage of oxygen, chronic hepatitis, COPD, and many more. It’s best to speak to a licensed agent to see if you have any health conditions that may affect your enrollment.

What is Medicare Supplement Open Enrollment?

Open enrollment is a time frame of when you can enroll in Medicare Supplements without having to answer medical questions.

Is Medicare Supplement Open Enrollment a one-time-only thing?

Yes, once you miss open enrollment for Medicare Supplements, there are no exceptions. However, if you are on Medicare before turning 65, you will receive a second open enrollment when you turn 65.

Do Medigap premiums increase with age?

No, they do not. While other things about your personal situation can cause your premium to rise, your age will never be one of them.

How to Get Help Applying For a Medigap Plan

Even with the previous explanation, it might not be any easier to navigate the Medigap plans on offer for you. That’s why our licensed insurance agents are readily available to answer all of your questions, or review plans with you.

Those agents are experts in all things related to Medicare and their only incentive is to match you with the best plan for your unique needs.

So give us a call today. Or quickly fill out our online rate form to access the best rates in your area.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.