Medicare Supplement

Enrollment Requirements

In order to Join a Medicare Supplement you must:

Have both Medicare Parts A and B
Be at least 65 years of age

In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.

Federal law doesn’t require companies to sell Medigap policies to people under 65.
Some states let you buy a Medicare Supplement if you’re eligible for Medicare because of ESRD or disability.

Enrollment Requirements

In order to Join a Medicare

Supplement you must:

Have both Medicare Parts A and B
Be at least 65 years of age

In some states, plans may be

available to persons under age

65 who are eligible for Medicare

by reason of disability or End-

Stage Renal Disease.

Federal law doesn’t require companies to sell Medigap policies to people under 65.
Some states let you buy a Medicare Supplement if you’re eligible for Medicare because of ESRD or disability.

When to Enroll

Open Enrollment: Is the period of time from when you are 65 years of age, under age 65 years of age and disabled, and have both Medicare Parts A and B. This period extends for a period of 6 months from when you have both Medicare Parts A and B. During this 6-month Open Enrollment period, you can enroll in a Medicare Supplement without underwriting. Insurance companies may not deny or condition the issuance of a policy on health status, claims experience, receipt of health care, or medical condition.Policies, however, may have a waiting period before preexisting health conditions are covered unless the beneficiary had prior “creditable coverage.” In addition, if under age 65 and on Medicare due to disability or end stage renal disease, the beneficiary will be entitled to a second six-month open-enrollment period upon reaching age 65.

Guaranteed Issue: Under certain circumstances you can enroll outside your Open Enrollment Period and have a guaranteed acceptance into a Medicare Supplement without medical underwriting, ensuring coverage regardless of health status. A beneficiary has the right to purchase a Medicare Supplement regardless of their health status if prior group health, Medicare Advantage, Medicare Supplement, or Medicaid coverage terminates.

The insurance company must offer a Medicare Supplement policy if:

When to Enroll

The insurance company must offer a Medicare Supplement policy if:

The employer group health plan ends some or all of their healthcare coverage (not of the beneficiary’s own choice);
The beneficiary enrolls into a Medicare Advantage plan when starting Medicare at age 65 and within 12 months they decide to disenroll from that plan;
The beneficiary drops their Medigap policy to join a Medicare Advantage plan, a Medicare Cost plan, or Medicare Select policy for the first time, and then the beneficiary leaves the plan or policy within the first 12 months after joining. However, they may only return to the policy under which originally covered, if available; or will get Guarantee Issue to purchase any Medicare supplemental policy;
The Medicare Advantage or Medicare Cost Plan stops participating in Medicare or providing care in the beneficiary’s service area;
The Medicare Supplement insurance company ends the Medigap or Medicare Select policy and the beneficiary is not at fault (for example, the company goes bankrupt);
The beneficiary moves outside a plan’s geographic service area;
The beneficiary leaves the health plan because it failed to meet its contract obligations;
The beneficiary has Medicare Parts A and B and are covered under Medical Assistance and subsequently loses eligibility for Medical Assistance (WI only);
The beneficiary’s group plan increases its (premium) cost from one 12-month period to the next (12-month period) by more than 25% and the new payment for the employer-sponsored coverage is greater than the premium charged under the Medicare Supplement plan the individual is applying for (WI only).

The employer group health plan ends some or all of their healthcare coverage (not of the beneficiary’s own choice);
The beneficiary enrolls into a Medicare Advantage plan when starting Medicare at age 65 and within 12 months they decide to disenroll from that plan;
The beneficiary drops their Medigap policy to join a Medicare Advantage plan, a Medicare Cost plan, or Medicare Select policy for the first time, and then the beneficiary leaves the plan or policy within the first 12 months after joining. However, they may only return to the policy under which originally covered, if available; or will get Guarantee Issue to purchase any Medicare supplemental policy;
The Medicare Advantage or Medicare Cost Plan stops participating in Medicare or providing care in the beneficiary’s service area;
The Medicare Supplement insurance company ends the Medigap or Medicare Select policy and the beneficiary is not at fault (for example, the company goes bankrupt);
The beneficiary moves outside a plan’s geographic service area;
The beneficiary leaves the health plan because it failed to meet its contract obligations;
The beneficiary has Medicare Parts A and B and are covered under Medical Assistance and subsequently loses eligibility for Medical Assistance (WI only);
The beneficiary’s group plan increases its (premium) cost from one 12-month period to the next (12-month period) by more than 25% and the new payment for the employer-sponsored coverage is greater than the premium charged under the Medicare Supplement plan the individual is applying for (WI only).

The employer group health plan ends some or all of their healthcare coverage (not of the beneficiary’s own choice);
The beneficiary enrolls into a Medicare Advantage plan when starting Medicare at age 65 and within 12 months they decide to disenroll from that plan;
The beneficiary drops their Medigap policy to join a Medicare Advantage plan, a Medicare Cost plan, or Medicare Select policy for the first time, and then the beneficiary leaves the plan or policy within the first 12 months after joining. However, they may only return to the policy under which originally covered, if available; or will get Guarantee Issue to purchase any Medicare supplemental policy;
The Medicare Advantage or Medicare Cost Plan stops participating in Medicare or providing care in the beneficiary’s service area;
The Medicare Supplement insurance company ends the Medigap or Medicare Select policy and the beneficiary is not at fault (for example, the company goes bankrupt);
The beneficiary moves outside a plan’s geographic service area;
The beneficiary leaves the health plan because it failed to meet its contract obligations;
The beneficiary has Medicare Parts A and B and are covered under Medical Assistance and subsequently loses eligibility for Medical Assistance (WI only);
The beneficiary’s group plan increases its (premium) cost from one 12-month period to the next (12-month period) by more than 25% and the new payment for the employer-sponsored coverage is greater than the premium charged under the Medicare Supplement plan the individual is applying for (WI only).

If the beneficiary meets one of the above conditions and they apply for their new Medicare Supplement policy within 63 calendar days after the prior health plan or policy ends, the Medigap insurance company:

Cannot deny insurance coverage or place conditions on the policy (such as a waiting period)
Must cover all preexisting conditions, and
Cannot charge more for a policy because of past or present health problems

The insurance company terminating coverage must provide notification that explains individual rights to guaranteed issue of Medigap policies. A copy of this notice (creditable coverage) or other evidence of termination will need to be submitted with the application for the new policy.

When Will Coverage be Effective?

Coverage is generally effective the first of the month following the month you enroll. However, you can choose an effective date up to 90 days in advance in most states.

Creditable Coverage

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that all health insurance issuers, group health plans and/or employer plans issue a HIPAA certificate of creditable coverage when health coverage ends. If certain conditions are met, this certificate will entitle the beneficiary to a reduction or total elimination of a preexisting condition waiting period under subsequent health benefits coverage obtained. This means the waiting period of benefits under a Medicare Supplement policy will also be waived or reduced based on the prior “creditable coverage.”

Examples of creditable coverage are:

Group Health Plan
Individual Health Insurance
Part A or Part B of Medicare
Tricare/Champ VA
Indian Health Service
Federal Employee Health Benefit
Public Health Plans
Peace Corps