When Can I Buy a Medigap ( Medicare Supplement ) policy?
Buying When You First Become Eligible
If you want the freedom of choosing from all of the Medicare Supplement policies that your state offers-- without restrictions and regardless of any current health issues-- your six-month Medicare Supplement open enrollment period is the best time to make your purchase. This enrollment period begins during the month in which you turn 65 and enroll in Medicare Part B.
Once the six-month enrollment period ends, you may be unable to purchase Medigap coverage. Additionally, any available policies may be more expensive.
Applying in the Open Enrollment Period
When you apply for your Medigap coverage during the open enrollment period, you are guaranteed acceptance. In addition, you receive the best price for your supplemental coverage.
Outside of your open enrollment period, based on the condition of your health, the cost of your Medigap policy could increase, or your policy application could be denied. Additionally, you could incur a denial for applying outside of the open enrollment timeframe.
Be sure to consider your situation as you pursue Medigap coverage. Your age and any group coverage that you have may affect your Medicare supplemental policy eligibility and cost.
What if You Are Already 65 or Older?
If you are already 65 or older, your open enrollment period for Medigap starts the day that you enroll in Medicare Part B. This enrollment period only comes around once and cannot be altered.
In most instances, you should enroll in Part B as soon as you are eligible. Otherwise, you risk having to pay a late-enrollment fee when you finally do apply for Part B coverage.
What if You Are Just Turning 65?
The most advantageous time to purchase your Medigap policy is during the six-month period that begins in the month in which you are 65 or older and have enrolled in Medicare Part B. For instance, if you reach 65 and enroll in Medicare Part B in January, the best period for you to purchase Medigap coverage is from January to June.
Once this enrollment period ends, your opportunity to purchase a Medicare Supplement may be restrictive and more expensive. Still, there are some states that offer additional periods of enrollment.
What if You Haven't Reached 65?
Insurance companies are not legally required to sell you a Medicare Supplement policy before your 65th birthday. If you have not reached 65, you may be unable to purchase the Medicare Supplement policy that you want. In fact, you may be unable to purchase any Medigap coverage.
Nevertheless, some states mandate Medigap insurers to sell you a Medicare supplemental policy even if you haven't reached 65. However, if you are allowed to purchase the supplemental coverage, you may have to pay more.
What if You Have a Group Health Policy Through a Union or Employer?
If you or your spouse is employed and you are currently covered by a group health policy through a union or employer, it may be best for you to wait before enrolling in Medicare Part B. Group plans that are offered by employers typically provide policies that are similar to Medicare Supplement plans, so you may not need Medigap coverage.
Once your employer plan ends, you will have an opportunity to enroll in Medicare Part B, and you won't receive a late penalty. With this option, your Medicare Supplement open enrollment period won't begin until it's most advantageous to you.
If you enroll in Medicare Part B before your employer coverage ends, your Medicare Supplement open enrollment period still starts. Without buying a Medigap plan that you may not need, you could end up missing your entire open enrollment for Medigap.
Buying Outside of the Open Enrollment Period
Once your open enrollment period has ended, Medigap insurers may deny your application for Medigap coverage due to health problems. Without meeting the insurance company's underwriting requirements, you may only be eligible under certain conditions.
Nevertheless, some states allow you to purchase a different kind of Medicare supplemental plan called Medicare SELECT. When you purchase a Medicare SELECT plan, you are given 12 months to replace it with a regular Medigap plan if you decide that Medicare SELECT is not for you.
Here are a few situations to consider as you attempt to buy a Medigap policy outside of the open enrollment period.
What if You Are Disabled or Have End-stage Renal Disease (ERSD) but Haven't Reached 65 yet?
Until you actually become 65, there is no federal law that forces insurers to sell a Medigap plan to you. If you haven't reached 65 but are Medicare-eligible because you are disabled or have end-stage renal disease (ERSD), you may be unable to purchase a Medicare Supplement policy.
Still, there are states that do require insurers to offer one or more types of Medicare supplemental coverage to Medicare beneficiaries who haven't reached 65. If you are unsure about the requirements of your state, the state's insurance department can confirm the details of your Medigap coverage rights.
What if You Have Health Problems?
If you are outside of your Medicare Supplement open enrollment period, a Medigap insurer can use medical underwriting to determine your eligibility. Based on your health, the insurance company can:
- Delay the start of your coverage
- Charge you a higher price for your Medicare Supplement policy
- Deny your application for Medigap coverage
Nevertheless, whether you have a health issue or not, there are instances when an insurer is required to sell you Medicare supplemental coverage. The insurer is mandated to offer you the opportunity to purchase a Medigap policy if:
- You are currently in your open enrollment period for Medigap.
- You have a Medigap protection or guaranteed issue right, requiring the insurer to sell to you.
There may be additional opportunities for you to purchase Medigap coverage. However, the Medigap insurer may still deny your policy application if you are in poor health.
What if You Have a Pre-existing Ailment?
If you have been diagnosed with a pre-existing condition, the insurer may be able to delay your Medigap coverage. Sometimes, the insurer may enforce a waiting period of up to six months before they start to cover any out-of-pocket expenses that are related to your pre-existing condition. After the waiting period expires, your Medigap coverage automatically includes your pre-existing ailment.
Still, as you receive a Medicare-approved service, your Medicare Part A and Part B policies continue to provide coverage even as your Medicare Supplement plan refuses to pay an associated out-of-pocket expense, such as your copayment or coinsurance.
Also, keep in mind that even with a pre-existing condition, the insurer can't enforce a waiting period if you had prior, ongoing creditable coverage in place for at least six months. For the insurer to consider the health insurance as creditable coverage, any gap in your coverage must be less than 63 days in duration.
In addition, your Medigap insurer cannot enforce a waiting period for a pre-existing condition if you have a guaranteed issue right.
For more information about buying a Medigap policy, contact our agency.