Can I Get a Medicare Supplement Plan Anytime?

Eligibility for Medicare Supplement Insurance hinges on several factors, including age, where you live, and when you apply.

Medicare benefits help with the cost of inpatient and outpatient medical expenses, but some medical services require you to pay a deductible, copayment, or coinsurance. If you want to purchase a Medicare Supplement plan (Medigap policy) to offset out-of-pocket costs, you must enroll in Original Medicare (Part A and Part B). Beyond that requirement, eligibility for Medicare Supplement Insurance is tied to your age, state regulations, and timely enrollment.

Eligibility for Beneficiaries Turning 65

Once you are Medicare eligible and sign up for Medicare Part B through Social Security, you have six months to apply for a Medigap policy, beginning with the month you turn 65. Medicare Supplement Insurance is standardized and labeled by letter in most states.

Plan A covers the basic benefits:

Medicare Part A hospital and hospice coinsurance, Medicare Part B coinsurance or copayment, and the first three pints of blood. The other Medigap policies build on those benefits and offer additional insurance coverage.

Plan F is the most comprehensive health plan, but eligibility is limited to beneficiaries eligible and not yet enrolled in Medicare before January 1, 2020. Plan G offers a robust Medigap health insurance plan for newly eligible beneficiaries, though it does not cover the Medicare Part B deductible.

Both Plan F and Plan G have a high-deductible version. The high deductible you must pay before the plan pays benefits is the trade-off for lower monthly premiums. In 2022, the deductible amount is $2,490.

Eligibility for Beneficiaries Under 65

Federal law does not protect Medicare beneficiaries younger than 65 who want to enroll in Medigap. However, some states require private insurance companies that sell Medicare Supplement Insurance to offer at least one plan with no medical underwriting to beneficiaries under 65 who are disabled or have end-stage renal disease (ESRD).

Every state runs a State Health Insurance Assistance Program (SHIP), which offers free local counseling to Medicare beneficiaries. Contact your local agency or one of our licensed insurance agents to find out the health coverage regulations in your state.

Medicare Supplement Enrollment Periods

The Medigap Open Enrollment Period differs from the annual Open Enrollment Period when you can join, change or leave Medicare Advantage plans.

During Medicare Supplement Open Enrollment, you can sign up for a Medicare Supplement policy without medical underwriting. Pre-existing conditions will not impact your plan options or premium rate. However, you are not guaranteed a policy after this window ends unless you have guaranteed issue rights.

Guaranteed issue rights

You may have a guaranteed issue right if you:

  • Are a member of a Medicare Advantage plan leaving the federal Medicare program or no longer servicing your area
  • Have moved out of your Medicare Advantage plan service area
  • Are a Medicare beneficiary with an employer or union health insurance plan that is terminating
  • Joined a Medicare Advantage plan the last year for the first time and now want to switch back to a Medigap policy

Four states have guaranteed issue rights for beneficiaries 65 and older:

  • Connecticut
  • Maine
  • Massachusetts
  • New York

When Is the Best Time To Enroll in a Medigap Policy?

If you do not have a guaranteed issue rights, the best time to enroll in Medicare Supplement Insurance plans is during the Medigap Open Enrollment Period.

The Medigap Open Enrollment Period:

  • It starts on the first day of the month that you turn 65
  • Extends for six months
  • Will not start unless you have Medicare Part B

Outside the Medigap Open Enrollment Period

Without guaranteed issue rights, a Medigap insurance company can decline applications received outside the Medicare Supplement Open Enrollment Period. If an insurer accepts your application, the insurance policy may come with exclusions for preexisting health problems if the health conditions were treated or diagnosed within six months of the policy start date.

If you are subject to a waiting period for pre-existing conditions, you can still get Medicare coverage under Original Medicare for covered services. However, you are responsible for all the out-of-pocket health care costs, which Medigap would have otherwise covered.

Prescription drug coverage

Medigap supplements medical costs for services and supplies covered by Medicare but does not include prescription drug insurance. If you want a prescription drug plan, you need to enroll in Part D. The initial enrollment period is the best time to sign up for Part D. Still; you also have an opportunity during the annual Open Enrollment Period, October 15 to December 7.

Resource Links

  • Medicare: This is the government website, but you can call 1-800-633-4227 to talk to someone live. The number for TTY users is 1-877-486-2048.
  • State Health Insurance Assistance Program: The site offers a navigator to help you find your local SHIP office and get answers to health care questions.
  • Medicare Supplement plan finder: Enter your zip code, and compare the Medigap plans in your search results.

Ready to learn more?

Making a decision on which Medigap Plan is best is not an easy decision. However, educating yourself on the different Medicare health plan types, comparing rates and policies, and talking to a licensed insurance agent will help you make the right choice.