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Who is Eligible for Medicare Supplement Insurance?

Supplemental Medicare insurance (aka, “Medigap”) is health insurance sold by private insurance companies to cover the “gaps” in Original Medicare. All Medigap policies supplement traditional Medicare coverage, Parts A and B, so you must qualify for Medicare Part A and Medicare Part B in order to be eligible for supplemental coverage. Age is the primary qualifying factor, however, there are also compatibility issues with other types of Medicare insurance.

Can people under 65 get Medigap insurance?

* Only available to people with ESRD.

** Not available to people with ESRD.

Although the insurance board in your state may not require insurers to sell Medigap policies to people under 65, some insurance companies do. In most cases, due to less competition and higher risk, the cost will be higher and you can be denied coverage for preexisting conditions. Be sure to visit your state’s board of insurance web page to review your rights.

Am I eligible if I have Medicare Part D?

Medicare supplements and Medicare Part D (prescription drug plans) are 100% compatible.  In fact, the combination of your Original Medicare, a Part D plan and a Medigap Plan F offers the most coverage you can buy.

If you have Medicare Part D and you like the benefits it offers, there is no need to change when you purchase a Medicare supplement policy.  There are some Medicare insurance agents that will try to convince you that there are benefits in buying Part D from your Medigap insurer, but this is not the case.

Am I eligible if I have Medicare Advantage?

Medicare Advantage and Medicare supplements are not compatible.  In rare circumstances you might be eligible to enroll in

a Medicare Advantage Plan and buy a Medigap if you are eligible for “trial rights.”

Your trial rights (a 12 month period starting on your birth month) permit you to enroll in a Medicare Advantage Plan for a brief trial period when turn age 65.  Should you decide that Medicare Advantage is not to your liking, you can switch back to Original Medicare. Before going back to Original Medicare, you are eligible to apply for a Medigap policy.  Your agent will make sure that the effective date of the Medigap policy coincides with the end date of your Medicare Advantage Plan. That way you can avoid a breaks in your medical coverage.

In most cases you also have the right to buy a supplemental policy if:

  • You move out of your Medicare Advantage Plan’s service area;
  • You leave a Medicare Advantage Plan because the company has misled you or broken rules; or
  • Your Medicare Advantage Plan stops providing services in your area.

In all of these cases, you can purchase any Medigap Plan A, B, C, F, K, or L available by carriers in your state. Don’t forget, however, that you are required to switch back to Original Medicare before you can purchase a Medigap policy.

Am I eligible for Medigap if I receive Medicaid?

Medicaid benefits are not the same as Medicare benefits, so Medigap policies do not apply.  If you have Medicaid, don’t forget that you will be covered through the new Affordable Care Act (“Obamacare”), starting 1 January, 2014, and will have the ability to get your healthcare coverage through your state’s health insurance exchange.

Compare Medicare Supplement Insurance Policies in Your State

Category: Insurance

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