Eligibility Requirements for Medigap

Calendar Icon Updated January 15, 2019
Medicare

Only those people who have Medicare Part A and Part B can buy a Medigap policy. Those who have a Medicare Part C Advantage Plan, cannot purchase this type of insurance.

Once you turn 65 and have Medicare Part B, you enter the Medigap open enrollment period. During this time, the insurance company can’t use medical underwriting to determine whether or not it will offer you a policy. This means it can’t do any of the following things as a result of your health issues:

  • decline to sell you a Medigap policy
  • insist that you wait for a period of time before coverage begins (except in certain cases), or
  • charge you a bigger premium to get a Medigap policy.

After the open enrollment period ends, the insurance company can refuse to sell you a policy based on your health or charge you more, unless you have a guaranteed right to buy a Medigap policy. (This usually happens in cases where you lose your existing policy through no fault of your own.)

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When the Insurance Company Can Make You Wait for Coverage

In most cases, an insurance company can’t make you wait for your Medigap coverage to begin. However, if you have a pre-existing condition, you might have to wait for coverage for up to six months. This is called the “pre-existing condition waiting period.” After six months expires, the Medigap policy covers the costs associated with your pre-existing condition. (Your condition will still be covered during the pre-existing condition waiting period by Medicare, but the Medigap policy won’t cover the out-of-pocket costs.)

Medigap for Those Under Age 65

Some people under age 65 get Medicare due to having a disability or end-stage renal disease. However, these people may not be able to purchase the Medigap policy they want, or any Medigap policy at all, until turning 65.

While federal law doesn’t require insurance companies to sell Medigap policies to people under age 65, there are some states that require the insurance companies that sell this type of policy to offer at least one type of Medigap policy to those who are under 65 and have Medicare. (Certain states give the right to buy a Medigap policy to all people with Medicare under age 65, while other states only give this right to those people eligible for Medicare due to a disability or only to those with end-stage renal disease.)

Those who don’t live in one of the states offering Medigap to those under age 65 may be able to get a policy if the insurance company voluntarily decides to sell them one. These policies typically cost more than Medigap policies sold to those who are over age 65 and they will use medical underwriting.

Eligibility Team

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