For many seniors, Medicare Supplement insurance can cover some important gaps (hence its other name: Medigap) in their coverage. That said, they don’t cover six or so healthcare concerns, including vision or dental care, private nursing, long-term care, or hearing aids. They also do not include prescription drug coverage like Medicare Part D does. Still, Medigap can help seniors better manage their health care expenses by covering situations that Original Medicare health insurance policies won’t, such as copayments, deductibles, or care when traveling internationally.
If you’ve been wondering about whether a Medicare Supplement plan might be right for you, you’ll first need to determine whether you’re eligible for coverage. Although eligibility may vary from state to state (and even insurer to insurer), the following can serve as a good general guide to help determine whether you’re qualified.
You must be enrolled in Original Medicare
You must be enrolled in Original Medicare (that is, Medicare Part A and Part B) to be eligible for a supplement plan. You cannot purchase a supplemental policy if you are enrolled in just one of those parts, nor can you purchase a supplemental policy if you’re covered by Medicare Advantage and do not plan to switch to Original Medicare. Medigap plans are not stand-alone policies; Original Medicare will provide the hospital and medical coverage you need to go along with your supplement plan. You will be turned down for supplemental coverage if you are enrolled in anything other than Original Medicare.
You’ll likely need to be over age 65
Some people qualify for Medicare coverage due to disabilities or diseases (like end-stage renal disease or ALS), rather than age. If you have Original Medicare and are under the age of 65, your ability to obtain supplemental coverage may depend on where you live. Federal law doesn’t require private insurance companies to sell supplemental policies to those under the age of 65, but some states do. And while some insurers will sell these policies even when it’s not required of them, you could still be denied coverage depending on your circumstances or may be charged more for the policy.
You should apply during the Open Enrollment period
You can and should still apply for Medigap coverage if you are losing your current coverage. But keep in mind that you could be denied coverage if you have to apply outside the Open Enrollment period for Medicare Supplement insurance. This period begins the month you turn 65 and lasts for six months total. If you apply for supplemental coverage during this timeframe, your insurer cannot deny you coverage or charge you more based on pre-existing conditions. After this period of time is up, however, insurers can consider your health status and could reject your application or charge you more as a result. So while you won’t necessarily be considered ineligible if you apply outside this enrollment period, it is a real possibility if you have pre-existing conditions.
While Medicare Supplement insurance may not be right for every individual or every situation, this coverage is vital for many seniors with significant health expenses or who will be losing their current coverage. To find out more about supplemental plans and how they might work for your situation, contact us today.
Medicare.com: “Can I Be Turned Down For Medicare Supplement Insurance?”
Medicare.com: “Eligibility For Medicare Supplement (Medigap) Plans”
Medicare.gov: “What’s Medicare Supplement Insurance (Medigap)?”