Medicare and Medigap Blog

Medigap Eligibility

Insurance companies must sell you a Medigap (Medicare Supplement) plan during certain periods of time — one period is called "open enrollment period." The others are called "guaranteed issue periods."

At other times, insurance companies may refuse to sell you a policy. If you have or used to have health problems, you may not be able to buy the Medigap plan of your choice. Most companies will have a few simple health questions that your Medigap360 Medicare Supplement Specialist can ask you to determine your eligibility.

Eligibility: Open Enrollment & Guaranteed Issue Periods

Open Enrollment

Seniors: Medigap companies must sell you a policy - even if you have health problems - if you are at least 65 and apply within six months after enrolling in Medicare Part B. These six months are called your "open enrollment" period. During open enrollment, a company must allow you to buy any of the Medigap plans it offers. You can use your open enrollment rights more than once during this six-month period. For instance, you may change your mind about a policy you bought, cancel it, and still have the right to buy any other Medigap policy, so long as the sale takes place during the six months after you enroll in Medicare Part B.

Although a company must sell you a policy during your open enrollment period, it may require a waiting period of up to six months before covering your pre-existing conditions. Pre-existing conditions are conditions for which you received treatment or medical advice from a physician within the previous six months.

Your right to open enrollment is absolute, even if you wait for several years after you become 65 to enroll in Medicare Part B because of continued employment or other reasons.

People with disabilities: People under age 65 who receive Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right is only applicable to Medigap Plan A. Companies selling Medicare supplement insurance in Texas may not deny you a Plan A policy because you have pre-existing conditions. Companies are not required to offer the other plans to Texans with disabilities, but they may do so if they wish. During the first six months after you turn 65 and are enrolled in Medicare Part B, you will have a right to buy any of the 12 plans.

Guaranteed Issue

You may have the right to buy a Medigap policy outside of your open enrollment period if you lose certain types of health coverage. For people over age 65, the guaranteed issue right applies to Medigap plans A, B, C, F, K, and L. For people under age 65, this guaranteed issue right applies only to Medigap Plan A. In general, this right is for 63 days from the date coverage ends or from the date of notice that coverage will end. Companies may not place any restrictions, such as pre-existing condition waiting periods or exclusions, on these policies. This is called "guaranteed issue." You must provide proof of the loss of your health care coverage. Texans under age 65 with disabilities who enroll in Medicare Part B also have guaranteed issue rights, but they are only eligible for Medigap coverage under Plan A. This guaranteed issue right is also extended to people on Medicare who lose Medicaid because of a change in their financial situation.

Guaranteed Issue and Medicare Advantage Plan Disenrollment

What often goes unnoticed about Medicare Advantage Plans is that they reserve the right to terminate their contract with Medicare from year to year in any service area that they wish. When this happens, you will no longer be able to continue with your plan and will be placed back on Original Medicare at the beginning of the following year.

If your Medicare Advantage plan terminates its contract in your service area, you have the right to purchase any Medigap plan A, B, C, F, K, or L offered in your state without regard to your medical history or condition. If your Medicare Advantage plan ends services in your area, it must explain to you in writing your options and timeframes to buy a Medigap policy.

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Brandon Todd is a Patient Advocate, a Licensed Insurance Agent and a Passionate Entrepreneur with a passion for creating unique and abundant win-win relationships.

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