Medigap Enrollment: Medicare Supplement Open Enrollment

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What is the open enrollment period for Medicare supplements?

Over 47 million individuals over the age of 65 have Medicare as their primary source of health insurance. Still, Medicare alone will not pay for all your care, and will have gaps in coverage. Many Medicare beneficiaries want additional help paying some of these outstanding Gap costs. That’s where a Medigap plan (Medicare Supplement) will help you.

Medigap plans help fill gaps left by Medicare. Consider enrolling in Medicare Supplement plan if you want to be protected from the high cost of medical bills. Let Senior Market Agents Network help you get MediGap Coverage today, so you are fully protected.

What is the Medicare supplement enrollment process?

Your eligibility for Medigap coverage usually starts around the time you first qualify for Original Medicare.

When should I apply for Medicare supplements?

• If you are turning 65: This is the time when most seniors become eligible for Medicare. You become eligible for Medigap plans during a 6-month period that starts on the first day of the month you turn 65 and are enrolled in Part B coverage. To clarify, this is the first day of the month you meet both stipulations. After the six months, you might find it more expensive to enroll in Medigap, and you might have a limited choice of plans.
• If you are 65 or older: You become eligible for Medigap after you enroll in Part B coverage. Again, this is a 6-month period. You should enroll in Part B coverage as soon as you become eligible, or you might pay a late enrollment fee. You cannot change or repeat this enrollment period.
• If you are under 65: Sometimes, those with Medicare under age 65 do not qualify for Medigap coverage. However, certain states require insurers to offer plans for those under 65.
• If you have health insurance from an employer: Those who have health insurance through their employer or union might not enroll in Medicare until awhile after they turn 65. However, when you do decide to enroll in Medicare, you will likely qualify for a standard enrollment period. Therefore, you will also receive a 6-month Medigap enrollment period. If you get Part B while you still work, the Medigap enrollment period will begin at that time regardless of whether you have employer-provided coverage as well.

Keep in mind: Medigap plans only apply to one person at one time. So, if both you and your spouse want Medigap coverage, then you must buy two plans. Two premiums will apply.

For Customers Dropping Medicare Advantage Coverage:

If you decide to switch from an Medicare Advantage plan back to Original Medicare, you can often re-enroll in a Medigap plan. You can also switch to Original Medicare and Medigap if:

      * It’s during the Open Enrollment Period (OEP) January 1 – March
        31. Health Questions will apply for Plan G and Plan N.

     * If you switch from a Medicare Supplement to a Medicare Advantage Plan
        for the first time.

• The insurer providing your Medicare Advantage coverage goes bankrupt
• You move out of your Medicare Advantage plan’s service area
• The Medicare Advantage plan’s insurer stops providing this plan in your area
• Your insurer leaves the Medicare Advantage system altogether

Remember, you must go back to Original coverage before enrolling in a Medigap plan.

What are the Costs?

Medigap does not come free. Most cost requirements are:

• You will pay a monthly premium to the insurer that provides the Medigap plan.
• You will continue to pay your Original Medicare Part B premium.

The average price for a Medigap plan is around $125-$200+ per month. However, the premium will vary based on the plan you choose, your age, your location and other factors.

Medicare Supplement Open Enrollment vs. Guaranteed Issue

In certain cases, insurance companies must at least offer you a Medigap policy regardless of extenuating circumstances. This is when you enter a guaranteed issue scenario.

Guaranteed issue usually kicks in during a variety of cases, including:

• Your Medigap coverage ends through no fault of your own.
• You’re in a Medicare Advantage Plan, and your insurer is leaving Medicare.
• Your Medicare Advantage plan stops giving care in your area.
• You move out of the Medicare Advantage plan's service area.
• You leave a Medicare Advantage or Medigap plan because of improper actions by the insurer.
• You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
• You have Original Medicare and a Medicare SELECT policy, and you move out of the SELECT policy's service area.
• You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65. Within the first year of joining, you decide you want to switch to Original Medicare. This is a Trial Right scenario.
• You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back to Original coverage. Trial Right rules again apply.

Guaranteed issue plans must cover all pre-existing condition scenarios. The insurer also can’t charge you more for any past or present health problems.

What is Medigap coverage?

Medigap plans are private insurance policies that you buy from an insurance company. They can help you cover many costs that your Original Medicare won’t pay. Covered costs might include:

• Medicare copayments
• Parts A & B deductibles
• Coinsurance
• Certain other costs not paid by Medicare, such as emergency care if you travel internationally
• Excess charges from Medicare Part B. For example, if a doctor does not accept full Medicare, they can charge you a percentage more for their services. Medigap might cover such costs.

Here’s How It Works

If you have Medigap coverage, you will visit your doctor and present both your Original Medicare insurance cards and proof of the Medigap plan. Your Original coverage will then pay its portion of your costs. Afterwards, the Medigap plan will cover some or all remaining, residual costs.

Keep in mind, your Medigap plan will not cover everything, including:

• Prescription drug costs. To receive coverage, you must have a Medicare Part D prescription plan.
• Dental or vision care, including eyeglasses
• Hearing aids
• Long-term care, including private-duty nursing and care in nursing homes

What is Medicare Select?

Certain Medigap plans offer what is called Medicare SELECT coverage. With SELECT policies, you must visit doctors or hospitals in the plan’s provider network to receive full coverage. If you don’t, you might pay more for care.

Types of Medigap Insurance

How Medigap plans provide coverage will depend on the plan itself.

Medigap insurance comes in multiple shapes and sizes, most-often denoted by an assigned letter. Each state administers its own Medigap marketplace.* The offered plans usually include:

• Plan A
• Plan B
• Plan C
• Plan D
• Plan F
• Plan G
• Plan K**
• Plan L**
• Plan M
• Plan N

Each plan will offer different benefits. Therefore, you’ll need to work alongside your insurance agent to determine which plan is right for you. Keep in mind:

• Not all insurance companies will offer all Medigap plans.
• All Medigap companies must offer at least Plan A coverage.
• Companies selling more than one Medigap plan must offer either Plan C or Plan F.

Furthermore, some plans might not be available in some states. However, Medigap plans offer consistent coverage based on their letters. For example, buying a Part A plan in Texas will get you the same coverage as a plan offered in Pennsylvania. It is always to your greatest benefit to buy a plan offered in your local area.

* If you live in Massachusetts, Minnesota or Wisconsin, pay attention for differences between plans. These states structure their systems differently. However, all plans must offer the same basic benefits.

** Plans K and L cover out-of-pocket limits. Once you spend a certain out-of-pocket amount for Medicare services, the Medigap will cover 100% of remaining costs for the rest of the year.

Who qualifies for coverage?

Qualifications and restrictions for Medigap coverage exist:

• After age 65, you must enroll in Original Medicare Parts A & B to qualify for a Medigap plan.
• Certain Medigap plans cover those under age 65. However, this option is not available everywhere. Applicants under 65 must still qualify for Original Medicare.
• You must remain enrolled in Original Medicare if you have the Medigap coverage.

You do not qualify for a Medigap plan if:

• You have a Medicare Advantage (Part C) plan. You cannot switch from Original Medicare to Medicare Advantage and keep your Medigap Plan.
• Most people who have Medicaid cannot use a Medigap plan.

Talk to one of our agents to learn more about your exact qualifications.

If you want a Medigap policy, talk to your agent. Usually, a few simple questions will help them determine your eligibility for a plan. Let Senior Market Agents Network help you get the Medigap plan you need. We’re ready to guide you in making the right plan choice. Call us at 877-209-4949 now.