Can I Enroll In a Medicare Supplement Plan at Any Time?
The first and biggest requirement when purchasing a Medicare Supplement plan (Medigap policy) is enrolling in Original Medicare (Part A and Part B). Beyond that requirement, eligibility for Medicare Supplement Insurance is tied to your age, state regulations, and timely enrollment.
Medigap Eligibility for Beneficiaries Turning 65
For Medicare beneficiaries turning 65, choosing a Medicare Supplement (Medigap) plan is an important decision. These plans help cover out-of-pocket costs like deductibles, copayments, and coinsurance that Original Medicare doesn’t pay.
The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period (OEP), which begins the first month you are both 65 and enrolled in Medicare Part B. This six-month window is crucial because:
- Guaranteed Issue Rights: You can enroll in any Medigap plan available in your state without medical underwriting – meaning insurers can’t deny you coverage or charge you higher premiums due to health conditions.
- Wider Plan Availability: You have access to all Medigap plans sold in your area.
Can You Get a Medigap Plan After Your Open Enrollment Period?
Yes, but with restrictions. If you apply for a Medigap plan after your six-month Open Enrollment Period, insurers can require medical underwriting.
This means they can:
- Deny coverage based on your health history
- Charge higher premiums due to pre-existing conditions
- Impose waiting periods before covering certain conditions
Medigap Eligibility for Beneficiaries Under 65
Are Medigap Plans Available for Those Under 65?
Medigap plans are not federally required to be offered to Medicare beneficiaries under 65. However, many states mandate insurance companies to sell at least one Medigap plan to those who qualify for Medicare due to disability or End-Stage Renal Disease (ESRD).
- State-Specific Rules: Some states offer only a limited selection of Medigap plans for those under 65, while others provide broader options.
- Higher Premiums: If available, Medigap plans for those under 65 often come with significantly higher premiums compared to those offered at age 65.
When Can You Enroll in a Medigap Plan Under 65?
If your state requires insurers to offer Medigap plans to beneficiaries under 65, you typically have a six-month Open Enrollment Period that begins when you first enroll in Medicare Part B. During this time:
Guaranteed Coverage: You cannot be denied a Medigap plan due to pre-existing health conditions.
Higher Costs: Insurers must offer you a plan, but premiums are often higher.
If your state does not require insurers to offer Medigap to those under 65, you may have to wait until you turn 65 to enroll in a plan with guaranteed rights.
Alternative Coverage Options for Those Under 65
If a Medigap plan isn’t available or affordable in your state, you may have other coverage options to help with Medicare’s out-of-pocket costs:
- Medicare Advantage (Part C): A bundled alternative to Original Medicare that includes hospital and medical coverage, often with additional benefits and an annual cap on out-of-pocket expenses.
- State Medicaid Programs: If you qualify based on income and resources, Medicaid can help cover Medicare-related costs such as premiums, deductibles, and copayments.
- High-Deductible Medigap Plans: Some states offer these as a lower-cost alternative, though you’ll have to meet a higher deductible before coverage kicks in.
Understanding State-Specific Medigap Rules
Federal law does not require private insurance companies to offer Medigap plans to Medicare beneficiaries under 65. However, some states have protections in place that mandate insurers to offer at least one Medigap plan – without medical underwriting – to those who qualify for Medicare due to disability or End-Stage Renal Disease (ESRD).
Since Medigap rules vary by state, you can access free, state-specific guidance through your State Health Insurance Assistance Program (SHIP). One of our licensed insurance agents can also help you understand your eligibility and explore your coverage options.
Can I Enroll at Any Other Times?
The only time you can sign up outside of the Open Enrollment Period is if you have guaranteed issue rights.
You may have a guaranteed issue right if you:
- Are you a member of a Medicare Advantage plan leaving the federal Medicare program or no longer servicing your area?
- Have moved out of your Medicare Advantage plan service area.
- Are you a Medicare beneficiary with an employer or union health insurance plan that is terminating?
- Joined a Medicare Advantage plan last year for the first time and now want to switch back to a Medigap policy.
Four states have guaranteed issue rights for beneficiaries 65 and older. If you are 65 or older, you can enroll outside of the Open Enrollment period without being subject to medical underwriting.
The four states are:
- Connecticut
- Maine
- Massachusetts
- New York
Pre-existing Conditions
The insurance company can impose a six-month waiting period if you buy a Medicare Supplement plan outside of your open enrollment period and have a pre-existing condition.
The carrier will cover other health conditions but can refuse to cover out-of-pocket costs relating to the pre-existing condition. After the pre-existing condition waiting period ends, the insurance carrier will cover those costs.
When Is the Best Time to Enroll in a Medigap Policy?
If you do not have guaranteed issue rights, the overall best time to enroll in Medicare Supplement Insurance plans is during the Medigap Open Enrollment Period. Without guaranteed issue rights, a Medigap insurance company can decline applications received outside the Medicare Supplement Open Enrollment Period.
If an insurer accepts your application, the insurance policy may come with exclusions for preexisting health problems if the health conditions were treated or diagnosed within six months of the policy start date.
If you are subject to a waiting period for pre-existing conditions, you can still get Medicare coverage under Original Medicare for covered services. However, you are responsible for all the out-of-pocket health care costs, which Medigap would have otherwise covered.
How to Enroll in a Medicare Supplement Plan: A Step-by-Step Guide
Enrolling in a Medicare Supplement (Medigap) plan is an essential step in ensuring comprehensive healthcare coverage beyond what Original Medicare (Parts A & B) provides. I’ll walk you through the enrollment process, how to compare companies and rates, and what information you’ll need to get started.
Step 1: Compare Medicare Supplement Plans & Rates
Before enrolling in a Medicare Supplement plan, it’s important to compare:
- Company Reputation: We’ll help you look at insurers with strong financial ratings and customer service reviews.
- Plan Options: While benefits are standardized (Plan G, Plan N, etc.), pricing varies by company and location.
- Premium Rates: Prices differ based on age, location, gender, and tobacco use.
- Rate Increase History: Check past rate increases to see how stable the company has been over time.
Step 2: Gather the Information You Need to Enroll
To complete your Medicare Supplement enrollment, you’ll need:
Medicare Claim Number (found on your red, white, and blue Medicare card)
- Date of Birth
- Full Name (as it appears on your Medicare card)
- Address & Phone Number
- Premium Payment Method (Bank draft or paper billing)
Step 3: Find the Best Medicare Supplement Plan for You
Once we help you compare companies and rates, the next step is choosing the right plan.
Here’s how:
- If you want comprehensive coverage, Plan G is the most popular choice, covering all out-of-pocket costs except the Part B deductible.
- If you’re looking to save money on premiums and are comfortable with some out-of-pocket costs, Plan N is a great alternative.
Step 4: Enroll Over the Phone
Once you’ve selected a plan, we’ll assist you in completing your enrollment over the phone. This is a simple and quick process that ensures accuracy and convenience.
Step 5: Receive Your Policy & ID Cards
After your enrollment is finalized, you can expect to receive your:
- Policy documents
- ID cards
These should arrive within 7 to 10 business days after the policy becomes effective.
Enrolling in a Medicare Supplement plan doesn’t have to be complicated. By comparing rates, selecting the right plan, and providing the necessary information, you will feel confident that you have taken all necessary steps to secure the best plan option.
Ready to Learn More?
Choosing the right Medicare Plan is not a decision that should be taken lightly. With Policy Guide’s assistance, you will have access to the knowledge and expertise of professional agents who can help you compare different health plans, quotes, and policies to ensure that you make an informed decision. Let us guide you through this process so that your chosen plan best suits your needs.
Article Resources
- Can I Get a Medicare Supplement Plan Anytime?
- Medicare Eligibility: This is the government website, but you can call 1-800-633-4227 to talk to someone live. The number for TTY users is 1-877-486-2048.
- Medicare Supplement Plan Finder
