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 your options will boost the likelihood that you will 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 receive Medicare benefits, you can enroll at any time. Since private companies provide the plans, you can’t simply enroll online. 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. Usually, your open enrollment begins six months before your 65th birthday or Part B start date. It continues for six months after your Medicare Part B starts.
Suppose you have a qualifying illness or disability qualifying for Medicare before 65. In that case, you will get a second open enrollment as you approach your 65th birthday.
You can choose any plan you want when you are in your open enrollment. 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.
Remember that some carriers may not accept you or give you a higher rate based on your health outside 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 to get a Medicare Supplement without qualifying medically. 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 a Medigap Select plan currently insures you. In that case, you move out of the coverage area, or the plan stops offering coverage in your area.
- Mislead – Your agent misled you.
- Bankrupt – Your current Medigap company becomes insolvent.
- Involuntary loss of group employer coverage – You are losing your group employer coverage of no fault.
- Trial-Right 1 – You start Medicare and elect a Medicare Advantage plan. Within 12 months of the plan, you decide to return to your Original Medicare.
- Trial-Right 2 – Suppose you have been on the 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 in most 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 must 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, Cystic Fibrosis, Dementia, and Alzheimer’s will always decline your coverage. Every carrier has slightly different underwriting, so you must speak to an agent who 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 it 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 whether you can 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. 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 an 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 your health conditions may affect your enrollment.
What is Medicare Supplement Open Enrollment?
Open enrollment is when you can enroll in Medicare Supplements without answering medical questions.
Is Medicare Supplement Open Enrollment a one-time-only thing?
Yes, there are no exceptions once you miss open enrollment for Medicare Supplements. 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 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, navigating the Medigap plans on offer might not be any easier 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.
