Medigap Eligibility and Policy Buying Guide for Medicare

To be eligible for Medigap, you must have Medicare Part A and be at least 65 years old, or have a disability.

You can buy a Medigap policy from a private insurance company, but you must be enrolled in Medicare Part B.

Medigap policies are standardized, meaning they have the same benefits, regardless of the insurance company you choose.

You can apply for a Medigap policy during your Medigap Open Enrollment Period, which starts on the first day of the month in which you turn 65 and enroll in Medicare Part B.

To be eligible for Medicare supplement insurance plans, you must be a legal U.S. citizen or permanent resident for at least five consecutive years and enrolled in Parts A and B.

You typically need to be 65 or older to enroll in a Medigap plan, but some insurance carriers offer plans to those under 65. These plans are standardized by the federal government, meaning each plan is consistent across different insurance carriers, even though prices may differ.

Your Medigap open enrollment period lasts for six months after your Part B effective date, during which you have guaranteed issue rights to any Medigap plan. This means you cannot be turned away due to any health conditions or health history reports.

You're automatically enrolled in Medicare Part A when you turn 65 if you're receiving Social Security benefits. This also applies to Medicare Part B in some cases.

Your unique open enrollment period for Medicare supplements begins once you're enrolled in both parts. This period lasts for six months after your Part B effective date.

During this time, you have guaranteed issue rights to any Medigap plan. This means you can't be turned away due to health conditions or health history reports.

Medigap policies cover only one person, so families should research family health plan options for coverage of multiple individuals.

Here's a brief summary of your eligibility at age 65:

If you're under 65 and eligible for Medicare due to a disability, you may have limited Medigap plan options. Usually, only the basic Plan A is available in most states.

You'll likely pay higher premiums for Medigap Plan A compared to those over 65. In some cases, premiums can be double or triple the amount.

Some states, like North Carolina, have different rules. North Carolina guarantees eligibility to purchase Medigap policy A, D, or G for individuals under 65 who qualify for Medicare due to disability.

You'll still have the opportunity to choose a new plan with guaranteed issue rights when you turn 65.

Medigap plans don't cover every possible cost, but there are comprehensive options available. Medigap Plan F is the most comprehensive, covering the Part B deductible and Part B excess charges, but it's only available to those who became eligible for Medicare on or before January 1, 2020.

If you don't qualify for Plan F, Plan G is the next best option, covering Part B excess charges, but not the Part B deductible. Guaranteed issue rights allow you to purchase a Medigap plan or change plans without medical underwriting, and insurers must sell you a plan and cover all your pre-existing conditions without charging a higher rate.

These rights are typically triggered by changes to your insurance coverage, such as moving outside of your Medicare Advantage plan's service area. Outside of the initial Medigap enrollment period, insurers use medical underwriting to decide whether to offer you a Medigap policy and at what price.

Here are some common situations that trigger guaranteed issue rights:

Keep in mind that insurers can deny you a Medigap policy due to your medical history or charge higher rates because of your current or past medical conditions.

The Open Enrollment Period is a six-month window where you can enroll in any Medigap plan offered in your state without facing medical underwriting or higher premiums.

During this period, you won't be denied coverage or pay more based on your age or health issues. This is a great opportunity to review your options and choose a plan that suits your needs.

The Open Enrollment Period starts when you're first eligible for Medicare Part B, and it's a one-time event. If you miss this window, you'll need to apply for a Medigap plan outside of this period, where insurance companies can use medical underwriting to decide whether to accept your application.

You can apply for a Medicare supplement policy outside of your Open Enrollment Period, but you may face medical underwriting and potentially higher premiums or even denial of coverage. This is why it's essential to act during your Open Enrollment Period.

You won't be automatically enrolled in a Medicare supplement policy, so you'll need to apply directly with the insurance company that sells the specific policy you want.

To get started, decide which plan you want by comparing the benefits each plan helps pay for and choose a plan that covers what you need.

Medicare's interactive website tool is a great resource to compare Medicare supplement plans quickly and easily. You can enter your zip code, age, gender, and tobacco status to get started.

You can use the website to select "Plan Details" to review the coverage for each standardized Medicare supplement plan, or "View Policies" to review the list of companies offering that plan along with their estimated premiums.

It's a good idea to apply at least 30 days before you want the policy to start, but if you don't have 30 days, apply as soon as possible.

Here are the basic steps to buy a policy:

Keep in mind that prices can change at any time based on when you buy, your health conditions, and more, so it's essential to get a quote and review the information carefully.