Senior Educators: When can I apply for Medigap or Supplemental Plans?

You can join or leave a Medicare Supplemental or Medigap plan at any time of the year, but in most cases, you must be relatively healthy to be able to get coverage. There are some times, however, that you can enroll in a Medicare supplement without any restrictions on health concerns. The most common time is when you are new to Medicare Parts A & B and are 65 or above. This is the initial guarantee issue period and it lasts from 3-6 months before you start Medicare to 6 months after the month you meet all guarantee issue criteria. This is why many of our clients who are interested in traditional supplements sign up when they turn 65. Fortunately, Medicare recognizes that there are a number of special circumstances that also warrant guarantee coverage, and provide for many other guarantee issue periods where you can get coverage regardless of your health.

Should I get a Medigap supplemental plan when I turn 65?

Many of our clients choose to get a Medigap supplemental plan when they turn 65 to avoid the risk that they can not health qualify as they age. This is a personal choice, but it is the easiest time to get coverage. Increasingly, however, we have many clients who are continuing to work and get their healthcare from work beyond when they turn 65. If you plan on keeping your employer's group coverage after 65, we generally recommend that you delay beginning your Part B until you are ready to retire so that you save your Medigap guarantee issue period until you are ready to use it. Note that Medigap supplement coverage is generally less than $200 per month, so if you're paying a lot more for your group plan, you may be better off taking Medicare and getting a Medigap supplement.

What if I am under 65; am I guaranteed coverage?

Unfortunately, most insurance carriers do not provide Medigap supplemental plans for Medicare beneficiaries under 65 who qualify through disability. In addition, even if they do provide such coverage, it is not always guaranteed issue when you begin taking Medicare. Regardless of whether you qualify for Medicare due to disability or age, the initial guarantee issue period begins in most states when you have Medicare Parts A & B and are 65 or older.

When are the other times I can get coverage without health underwriting constraints?

Medicare recognizes that there are certain situations where Medicare beneficiaries are entitled to guarantee issue into Medigap supplemental because of changing needs, unique or extraordinary circumstances. The most common Medigap supplemental guarantee issue exceptions are for individuals moving out of plan coverage area, involuntary loss of employer group coverage or involuntary loss of Medicare Advantage plan coverage. The coverage periods are not standard for all of these situations, but can be as little as 63 days, so you will want to enroll in a Medigap suppelemental plan quickly.

In Medicare Advantage plan
- Plan stops coverage in your area
- you move out of plan's service area
In Original Medicare & Employer Group Health Plan
- Employer Group Health Plan coverage involuntarily ends
In Original Medicare Plan and have a Medicare SELECT policy
- Move out of Medicare select area
(Trial right) Joined a Medicare Advantage Plan or PACE when you were first eligible for Part A at 65
- within first 12 months, you decide to switch to Original Medicare & Medigap
(Trial right) dropped a Medigap policy to join MA for the first time
- Within first 12 months, you decide to switch to Original Medicare & Medigap
- Can choose former Medigap plan from former company
Your Medigap company goes bankrupt or you otherwise lose coverage through no fault of your own
Leave MA Plan or drop Medigap because company hasn't followed the rules or it has misled you.