by Russell Noga | Updated January 14th, 2024
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What Does Medigap Cover?
Medigap is a supplemental insurance policy complementing your Medicare Parts A & B policies. You must have both to enroll in Medigap. Medigap provides supplementary coverage for the following healthcare services covered or not covered by Original Medicare Parts A & B.
- Medicare Part A hospice copayments or coinsurance costs
- Medicare Part A hospital fees and coinsurance.
- Medicare Part B coinsurance or copayment costs
- blood transfusion costs up to the first 3 pints.
In addition, some Medigap plans also cover the following:
- Skilled nursing facility care costs.
- Medicare Part A deductibles.
- Medicare Part B deductibles.
- Medicare Part B excess fees.
- 80% of expenses involved in emergency medical costs during foreign travel
Can I Enroll in Medigap If I Have a Group Health Plan with My Employer or Union?
If you’re currently involved with an employer’s Medicare scheme or belong to a union. You’ll want to wait to enroll in Original Medicare Part B. Employer healthcare plans usually provide coverage similar to what you get with Medigap, so you don’t require the coverage offered by a Medigap policy.
You can enroll in Original Medicare Part B, with no penalties, when your employee coverage ends. Your open enrollment period into Medigap only starts when these befits end. If you enroll in Part B while still using your employer’s Healthcare plan, your Part B coverage and Medigap open enrollment window start from this date.
Special Conditions for Enrolling in Medigap
If you’re under 65 and have a disability or an acute pre-existing condition like ALS or End-Stage Renal Disease (ESRD), you can’t enroll in Medicare and Medigap policies. Typically, Federal law doesn’t require insurers to provide Medigap plans to people under 65. However, some US states provision insurers to sell Medigap to people under 65 with these health conditions. These states are the following.
- Arkansas
- Kentucky
- New Jersey
- California
- Louisiana
- New York
- Colorado
- Maine
- North Carolina
- Connecticut
- Maryland
- Oklahoma
- Delaware
- Massachusetts
- Oregon
- Florida
- Michigan
- Pennsylvania
- Georgia Minnesota
- South Dakota
- Hawaii
- Mississippi
- Tennessee
- Idaho
- Missouri
- Texas
- Illinois
- Montana
- Vermont
- Kansas
- New Hampshire
- Wisconsin
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Can You Enroll in Medigap If You Have a Pre-existing Health Condition?
If you apply for a Medigap policy within the open enrollment period, the insurer cannot deny you access to its Medigap scheme. They also can’t charge you higher premiums on your policy. They also can’t issue a waiting period with activating your benefits.
You can choose any plan from any provider and get immediate coverage for your additional medical expenses not covered by original Medicare. So, if you have a pre-existing health condition, such as diabetes or sleep apnea, it’s best to take advantage of the open enrollment window. Register a Medigap policy as soon as possible to avoid medical underwriting.
However, the Medigap insurer may sometimes refuse to cover the out-of-pocket expenses involved with your healthcare costs if you apply outside of the open enrollment period. The waiting period can last three to six months and varies between insurers.
After completing the waiting period, the Medigap policy will cover all the treatments and care associated with your pre-existing condition. However, this isn’t always the case. Some insurers might decide your pre-existing health status bears too much risk for the company, causing them to deny your Medigap application.
New enrollees in Medigap plans can shorten or avoid waiting periods for pre-existing conditions if they buy a Medigap policy during the Medigap open enrollment period, using it to replace their “Creditable coverage ” (Medigap).”
Applicants with a minimum of six months of continuous prior creditable coverage with another Medigap plan or provider usually won’t have to wait. Many other types of private healthcare coverage also count towards Creditable Coverage for buying a Medigap policy.
However, the insurer will likely only count this prior coverage if it was continuous for a minimum of 63 days before applying for your new Medigap policy.
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Can I Switch from Medicare Advantage to Medigap?
Yes. You can switch from Medicare Advantage policies to Medigap. You won’t have to undergo the medical underwriting process if you change within the first year of MA coverage. However, it’s illegal for private insurers to sell you a Medigap policy while you’re still a member of a Medicare Advantage plan.
Guaranteed Issue Rights
You might qualify for “guaranteed issue rights,” such as the Medicare Advantage example we just covered. With guaranteed issue rights, the Medigap insurer cannot reprimand your application to join its Medigap scheme with higher premiums, denial of coverage, or a waiting period.
If your employer recently ended their healthcare coverage, you move to a different area of the US where your MA plan no longer offers you coverage, or your Medigap provider goes bankrupt, you qualify for a guaranteed issue right to a Medigap scheme of your choosing.
Frequently Asked Questions
Can Medicare Supplement insurance plans be purchased at any time?
Medicare Supplement insurance plans, also known as Medigap plans, can generally be purchased at any time throughout the year. However, the best time to enroll is during the Medigap Open Enrollment Period.
What is the Medigap Open Enrollment Period?
The Medigap Open Enrollment Period is a six-month period that begins on the first day of the month in which you are both 65 years old or older and enrolled in Medicare Part B. During this period, you have guaranteed issue rights, meaning you can enroll in any Medicare Supplement plan without medical underwriting.
Can I purchase a Medicare Supplement plan outside of the Medigap Open Enrollment Period?
Yes, you can purchase a Medicare Supplement plan outside of the Medigap Open Enrollment Period. However, if you apply for a plan after your open enrollment period, the insurance company may subject you to medical underwriting, which means they can consider your health status when determining your eligibility and premium rates.
Are there any exceptions to purchasing a Medicare Supplement plan outside of the Medigap Open Enrollment Period?
In certain situations, you may be eligible for a guaranteed issue right that allows you to purchase a Medicare Supplement plan outside of the open enrollment period without medical underwriting. These situations include losing your existing coverage, moving out of your plan’s service area, or other specific circumstances.
What is the difference between Medicare Supplement Plan G and Plan N enrollment periods?
There is no specific enrollment period for Medicare Supplement Plan G or Plan N. These plans are available for enrollment at any time throughout the year, subject to the insurance company’s policies and underwriting guidelines.
Can I switch from one Medicare Supplement plan to another at any time?
Yes, you can switch from one Medicare Supplement plan to another at any time. However, if you want to change plans outside of your initial enrollment period or a guaranteed issue right, you may be subject to medical underwriting, which could affect your eligibility and premium rates.
Can I enroll in a Medicare Supplement plan if I have a pre-existing condition?
During your Medigap Open Enrollment Period, insurance companies are generally not allowed to deny you coverage or charge you higher premiums based on pre-existing conditions. However, if you enroll in a Medicare Supplement plan outside of this period, they may consider your health status and impose underwriting requirements.
What is the best time to purchase a Medicare Supplement plan?
The best time to purchase a Medicare Supplement plan is during your Medigap Open Enrollment Period. During this period, you have a guaranteed right to enroll in any plan of your choice without being subject to medical underwriting.
Can I change my Medicare Supplement plan later if I’m not satisfied with it?
Yes, you can change your Medicare Supplement plan at any time. However, if you want to switch plans outside of your Medigap Open Enrollment Period, you may be subject to underwriting and there is no guarantee that you will be able to obtain coverage or receive the same premium rates.
Where can I get more information about Medicare Supplement insurance plans and their enrollment periods?
To get more information about Medicare Supplement insurance plans and their enrollment periods, you can visit the official Medicare website, contact a licensed insurance agent who specializes in Medicare, or reach out to the State Health Insurance Assistance Program (SHIP) in your state for personalized assistance.
Call Us for Expert Advice in Enrolling in Medigap
If you’re unsure about when to enroll in Medigap, speak to the professionals. We offer you a free consultation on signing up for Medigap with any insurer. Our online calculator provides a way to find the insurer with the lowest rates in your state, giving you a free automated quote on your policy.
Or you can reach us directly at 1-888-891-0229 to discuss your needs. If you can’t talk right now, that’s okay. Complete the contact form on our site, and we’ll have a Medigap expert get in touch with you at a time that suits you.
Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.