Summary:
Medicare Supplement insurance plans are sold by private health insurance companies. Medicare Supplement insurance plans may haveeligibilityrequirements in some situations.
Medicare Supplement insurance plans eligibility with Original Medicare
What are Medicare Supplement Insurance plans?
Medicare Supplement insurance plans are intended to work with Original Medicare (Medicare Part A and Part B). They help pay some of the Medicare Part A and B out-of-pocket cost.To beeligible for a MedicareSupplement insurance plan, you must first enroll in Medicare.
What is the difference between Medicare Advantage and Medicare Supplement insurance plans?
Medicare Supplement, or Medigap, insurance plans are different from a Medicare Advantage Plans. Medicare Advantage plans are an alternative way to get you Original Medicare coverage, while a Medigap policy works with your Original Medicare benefits to cover cost.
What are the main qualifiers to be eligible for Medicare?
To be eligible for Medicare you must be a U.S citizen or permanent legal resident for at least five continuous years who have any one of the following qualifications:
- Aged 65 and older
- Diagnosed with end stage renal disease (ESRD – permanent kidney failure requiring dialysis or transplant)
- Receiving disability benefits from the Social Security Administration or the Railroad Retirement Board. Generally you’re eligible for Medicare after receiving disability benefits for 24 months in a row.
- Diagnosed with Lou Gehrig’s disease (ALS).
You may be automatically enrolled in Medicare Part A when you turn 65 and its premium-free for Part A for most people who have worked at least 10 years or more and paid Medicare taxes. In most cases, you’re also automatically enrolled in Medicare Part B, but pay a monthly premium for it.
What is the maximum out of pocket for Medicare Supplement insurance plans?
The 2023 out-of-pocket (OOP) limits for Medicare Supplement (Medigap) insurance plans K & L are $6,940 and $3,470, respectively. These increases in the limits are based on estimates of the United States Per Capita Costs (USPCC) of the Medicare program developed by the Centers for Medicare & Medicaid Services (CMS). Please keep in mind thatsome Medicare Supplement Insurance plans don’t have out of pocket limits in the same ways that Plans K & L do.
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What age are you eligible for Medicare Supplement insurance plan?
Do you have to be 65 to buy a Medicare Supplement?
In most states, one requirement for Medicare Supplement eligibility may be age. Federal law doesn’t require insurance companies to sell Medicare Supplement insurance plans to people under 65. If you are under 65 and have Medicare because of a disability or a certain health condition such as end stage renal disease (ESRD) or Lou Gehrig’s disease (ALS), you may not be able to buy theMedicare Supplement insurance planyou want, or any policy, until you turn 65. However, many states require insurance companies to offer at least one kind of Medicare Supplement insurance plan to people under 65 with Medicare.
Medicare Supplement insurance plan eligibility for people under 65
In some states, insurance companies may voluntarily sell Medicare Supplement insurance plans to people under 65, even though they are not federally mandated to do so. The insurance policies might cost more than the plans sold to people 65 and over, and the insurance company may be able to use medical underwriting (evaluating your health conditions in order to make policy decisions). This means that any health condition could result in a premium increase.
You canapplyfor a Medicare Supplement insurance plan anytime once you’re enrolled in Medicare Part A and Part B – you’re not restricted to certain enrollment periods as you are with other Medicare enrollment options. However, there are only certain periods or situations when you have guaranteed issue rights to buy a Medicare Supplement insurance plan. One such period is described below.
Medicare Supplement Open Enrollment Period
If you are 65 or older, you may be able to purchase a Medicare Supplement insurance plan during the Medicare Supplement Open Enrollment Period. This period lasts for six months and begins on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B. During this period is when you can buy Medicare Supplement insurance plans without the risk of being turned down or charged more because of a health condition. In some cases, a waiting period might apply. The practice of medical underwriting is what insurers use to evaluate health conditions when making policy decisions. During this Open Enrollment Period, medical underwriting cannot be used. Outside of this Open Enrollment Period, health problems and pre-existing conditions* may compromise your Medicare Supplement eligibility or make you pay more for a policy.
Once you have a Medicare Supplement insurance plan, you must continue to pay your monthly premiums to maintain coverage (as well as your Medicare Part B premium). Medicare does not cover any Medicare Supplement premium costs.
Here are some reasons you may be turned down from a Medicare Supplement insurance plan or pay a higher premium:
- You have Medicare but you’re under 65
- You’re 65 but haven’t enrolled in Medicare Part B
- You have a health problem and your Medicare Supplement Open Enrollment Period has ended
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.
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