Key Takeaways:
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The Medicare supplement Initial Enrollment Period (IEP) is the first six-months (180-days) of Medicare Part B coverage. During this window you can get any Medicare supplement plan available to you, without any consideration for your medical history. There is no medical underwriting. You can use this calculator to find your IEP.
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After the Medicare supplement IEP, you can enroll in or change Medicare supplement plans any day of the year, as often as you like. However, you must qualify medically to be approved for a new policy. An insurance company can deny your application or charge more for your new policy.
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Some states have special rules that override Medicare for the benefit of the consumer. These states may have special enrollment periods where you can get a policy without medical questions. There may be other limitations or restrictions depending on the state.
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Enrolling in Medicare Part B is what triggers your Medicare supplement policy Enrollment Period.
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Medicare Part D plans provide coverage for prescription drugs. Beneficiaries can access prescription drug coverage through both traditional Medicare and Medicare Advantage plans, with varying costs, coverage, and management restrictions.
Over 60 million US citizens are enrolled in Medicare. That’s approximately 20% of the entire US population. But while Original Medicare (Medicare Part A and Medicare Part B) can be incredibly beneficial, Original Medicare was never intended to be stand-alone insurance coverage.
Medicare supplement plans were designed to build on your Original Medicare, reducing your out-of-pocket expenses and providing the security of a maximum out-of-pocket limit on your financial liability.
Because it fills in the gaps in coverage left by Original Medicare, Medicare supplement plans are also referred to as Medigap Plans. Unlike Medicare Advantage Coverage (Part C Medicare), a Medigap plan doesn’t replace your Original Medicare but supplements it, paying for the out-of-pocket costs associated with Original Medicare coverage plans.
What Is a Medicare Supplement Plan?
In simple terms, a Medicare Supplement (aka Medigap policy) is health insurance that, as the name implies, supplements one’s Original Medicare plan by covering out-of-pocket costs associated with Medicare Part A and Part B, such as copayments, deductibles, and coinsurance.
Medigap plans are sold by private health insurance companies, with Original Medicare beneficiaries being able to choose between ten different Medicare plans (designated by letter), each offering a different level of benefits. We’ve created a helpful Medigap Plans comparison chart if you wish to learn more about them.
Medicare Supplement vs. Medicare Advantage Plans
What many people find confusing is that Medicare Supplement health insurance isn’t the same as a Medicare Advantage plan These two are often mistaken, and while there are several similarities, Medigap and Medicare Advantage (also called Medicare Part C) are two entirely different coverage options. They even have different enrollment periods.
As explained, Medigap plan supplement your Original Medicare Plan and can be purchased from a private insurance company. The supplement is then secondary insurance to Medicare. That means Original Medicare is primary and makes all decisions.
A Medicare Advantage Plan, however,replaces your Original Medicare coverage with a privatized version of Part A and Part B. As such, the Medicare Advantage Plan becomes your primary insurance coverage and the insurance company makes all decisions to approve or deny your coverage.
We cover Medigap and its differences from a Medicare Advantage plan in more detail in our comprehensive guide to Medicare Supplement insurance you can find under this link.
Who Is Eligible for Medigap Coverage?
To enroll in a Medigap plan you must first be enrolled in Original Medicare, Medicare Part A (hospital insurance) and Medicare Part B (outpatient insurance). That’s perfectly logical, as Medigap supplements your original policy.
In other words, to be eligible to enroll in Medicare Supplemental Insurance, you must first be eligible to enroll in Original Medicare, which you can do if:
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you are 65 years old;
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you have a qualifying disability and receive Social Security Disability Insurance (for at least 2 years);
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you have qualifying diseases, such as amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD).
An important point here is that even if you’re under 65 and enrolled in Medicare, you may be unable to supplement your insurance with Medigap. That’s because federal law doesn’t require offering Medigap policies to people under 65, even if they have disabilities and diseases that qualify them for standard Medicare coverage.
What Is the Medicare Supplement Open Enrollment Period?
Technically, there is not a Medicare Supplement Open Enrollment Period. The term “Open Enrollment” typically refers to the annual enrollment period for a Medicare Advantage plan or Medicare Part D plan.
A Medicare Advantage Plan and Part D prescription drug plans are annual plans. Their benefit structure ends December 31 of each year. The benefits and cost for the following year will be different than the current year. An Open Enrollment Period is required to allow the consumer to shop for a new plan for the following year, based on the new benefits and costs and on a guarantee issue basis.
benefits never change. Because the benefits never change, there is no need for an annual Medicare supplement open enrollment period. You can change plans whenever you wish, but not on a guarantee issue basis.
When Is Medicare Supplement Open Enrollment?
The Medicare Supplement Initial Enrollment Period (IEP) begins on the first day your Medicare Part B is effective. It is a six month period (180-days) starting the day your Medicare Part B coverage begins, during which a person can buy any Medigap policy available to them with a guaranteed issue. you cannot be denied coverage. This period is also referred to as the Medigap Open enrollment period.
During the Medigap open enrollment period a Medigap plan insurer can’t deny you supplemental coverage based on your medical history or pre-existing conditions nor charge you higher premiums because of them (a practice called “medical underwriting”). Once your six-month Medigap open enrollment period ends, it never occurs again, although some states have additional open enrollment periods.
Some states allow the consumer a brief window of time annually where they can can get Medicare supplement insurance either around their birthday (a birthday rule state) or around the policy anniversary (anniversary rule state). That period of time can be referred to as the Medigap Open Enrollment Period or Medicare Supplement Open enrollment window. Three states have perpetual open enrollment for Medicare supplement insurance.
What If I Missed My Medigap Open Enrollment Period?
If you miss your six-month Medigap Open Enrollment Period you can still apply for Medicare supplement insurance. If you do not have a recent history of significant critical or chronic illness, you will likely pass medical underwriting and get the Medicare supplement insurance policy you applied for.
While each insurer has different underwriting parameters, some of the medical conditions that can prevent your acceptance would include ongoing or very recent cancer (less than two years cancer free), history of AFIB or heart failure, diabetes with complications, osteoporosis with fractures, rheumatoid arthritis, Alzheimer’s or Parkinson’s or any condition that is requiring more than two medications to treat.
So, what are your options when enrolling outside your six-month enrollment window?
Enrolling Based on Your Guaranteed-Issue Rights
As you plan for your future healthcare needs, keep in mind that if you ever lose your medical insurance through no fault of your own, the Medicare program will provide a special Medigap open enrollment period for you. It is called a Special enrollment Period (SEP).
During a Special Enrollment Period, there are select Medicare supplement policies that will be available to you on a Guarantee Issue basis. These Medicare supplements can be offered by a licensed insurance agent or directly from Medigap insurers.
A guarantee issue SEP can be triggered by any of these events:
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Your existing Medigap plan shuts down;
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Your Medigap insurance company goes bankrupt;
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You were misled by your insurer;
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Your Medicare Advantage plan’s service area changes (or the plan shuts down);
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You enrolled in Medicare Advantage at 65 but decided to switch plans back to Original Medicare within a year (trial rights);
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Your employer coverage that supplemented Medicare ends;
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Your Medigap coverage ends due to no fault of your own.
If any of the above situations apply to you, you should qualify for a Medigap Open Enrollment. What’s more, we can help you find the appropriate Medigap insurer. Request a free quote using our form, and we’ll provide you with the best Medigap policy quote based on your specific needs.
Enrolling in Medigap During the Medicare Open Enrollment Period
If you miss your Medicare Supplement Open Enrollment Period and none of the potential guaranteed-issue situations apply to you, you can also enroll in Medigap during the next Medicare Annual Election Period or Medicare Advantage Open Enrollment Period:
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The Medicare Annual Election Period lasts from October 15 to December 7 each year. During this period, you can switch your Original Medicare plan to Medicare Part C or vice versa and join or leave Medicare Part D coverage (prescription drug policy). You can also choose a Medigap plan to supplement your existing Medicare insurance.
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The Medicare Advantage (Part C) Annual Enrollment Period starts on January 1 and ends on March 31. During this period, Medicare Advantage beneficiaries can switch or drop their Part C plans.
So yes, enrolling in Medigap during “standard” Medicare enrollment periods is possible. In fact, as long as you have Original Medicare and meet other Medicare Supplement requirements, you can enroll in a Medigap policy at any time. However, you can expect to pay more for your insurance if you don’t have guaranteed-issue rights. The insurer can also deny you coverage based on your health problems. A situation that is easily avoided by enrolling during your Initial Open Enrollment Period.
When Is the Best Time to Enroll in Medigap Insurance?
The best time to enroll in a Medicare supplement insurance plan is when you enroll in Medicare Part B. In most states, you can apply for a supplement up to six-months before the start of your Medicare supplement Open Enrollment Period, with a start date the same day your Medicare Part B starts
Therefore, it’s best to spend your time researching the best Medicare Supplement policies and agents before your initial open enrollment window opens. Doing that will ensure you don’t find yourself empty-handed and get your desired Medigap policy at the best price possible.
Medigap Open Enrollment Period FAQs
What is the Medicare Supplement Open Enrollment Window?
The Medicare Supplement Open Enrollment Period (Medigap Open enrollment) is a six-month window during which an Original Medicare beneficiary can enroll in a Medigap insurance policy. The period starts the first day of the month your Medicare Part B starts. Your current or past health status cannot be considered in your application. No pre existing conditions, no questions about present health problems.
Do I really need to supplement my Medicare policy with Medigap?
Buying Medigap isn’t required. It will, however, lower your out of pocket costs for medical services and set a maximum out of pocket limit on your financial risk.
Can I enroll in Medigap outside my Initial Open Enrollment Period?
Yes, as long as you have Original Medicare (not Medicare Advantage), you can freely apply for Medicare Supplement outside your Initial Open Enrollment Period. A Medigap company will look at your health history and you will answer health questions on the application.
Medigap Seminars is a truly independent Medicare insurance broker. We offer all Medicare supplement plans and most major Medicare Advantage plans. Reach out to us for professional, experienced guidance.
Understanding Medicare Enrollment Periods
Navigating the various Medicare enrollment periods can be confusing, but understanding them is crucial for making informed decisions about your healthcare coverage. Each enrollment period serves a specific purpose and has its own set of rules and timelines. Knowing when these periods occur and what actions you can take during them will help you avoid penalties and ensure you have the coverage you need.
Medicare Initial Enrollment Period
The Medicare Initial Enrollment Period (IEP) is a pivotal time for anyone approaching Medicare eligibility. This seven-month window begins three months before the month you turn 65, includes your birthday month, and extends three months after. During this period, you can enroll in Medicare Parts A and B, as well as Part D for prescription drug coverage. Missing this initial window can result in late-enrollment penalties, which can increase your premiums permanently. Therefore, it’s essential to understand your options and enroll in the appropriate Medicare parts during this time to avoid unnecessary costs and ensure comprehensive health insurance coverage.
Pre-Existing Condition Waiting Period
Understanding Pre-Existing Conditions
A pre-existing condition is any health issue you had before applying for a Medigap policy. Insurance companies may impose a pre-existing condition waiting period, which can last up to six months. During this period, your Medigap policy will not cover any costs related to the pre-existing condition. However, Medicare will continue to pay for treatment related to the pre-existing condition and other health issues. Understanding how pre-existing conditions affect your Medigap coverage is crucial for planning your healthcare needs effectively. This knowledge helps you anticipate any gaps in coverage and manage your healthcare expenses more efficiently.
Service Area and Medigap
Understanding Service Areas
While Medigap policies are standardized, the service area can vary depending on the insurance company and the specific policy. The service area defines the geographic region where your Medigap policy is valid and where you can access healthcare services. Some Medigap policies may have a limited service area, while others offer nationwide coverage. When choosing a Medigap policy, it’s essential to consider the service area to ensure it aligns with your healthcare needs and lifestyle. For instance, if you travel frequently or live in multiple states throughout the year, a policy with nationwide coverage might be more suitable. Understanding the service area of your Medigap policy will help you make an informed decision and ensure you have access to the healthcare services you need, wherever you are.
