Medicare Supplement Enrollment

Enrolling in Medigap

Individuals can enroll or change Medigap plans at any time, but when they do can influence the availability and cost of the plan.

Underwritten Medigap plans require applicants to answer questions regarding their health, including details about pre-existing conditions and prescribed on-going treatments/medications. Depending on answers, some individuals may be denied or be required to pay a higher premium. Underwritten applications can be submitted to most carriers up to 60 days in advance. Without prior approval, the 10th of each month is the cutoff date to submit a policy for the next month.

Common Conditions & Causes for Denial of Medigap Coverage
Aids ALS (Lou Gehrig’s Disease) Alcohol/Drug abuse Dementia Chronic Bronchitis COPD Cystic Fibrosis Cirrhosis Congestive Heart Failure Diabetes	Emphysema End Stage Renal Disease Fibromyalgia Heart Disease Hepatitis Immune Disorders Multiple Sclerosis Lupus Kidney Disease (w/ dialysis) Mental/Nervous disorder	Myasthenia Gravis Organ transplant Osteoporosis Stroke Advised surgery/treatment Implantable Cardiac Defib Use of supplemental oxygen Use of a nebulizer Asthma with 3+ medications

Common Conditions & Causes for Denial of Medigap Coverage
Aids ALS (Lou Gehrig’s Disease) Alcohol/Drug abuse Dementia Chronic Bronchitis COPD Cystic Fibrosis Cirrhosis Congestive Heart Failure Diabetes Emphysema End Stage Renal Disease Fibromyalgia Heart Disease Hepatitis Immune Disorders Multiple Sclerosis Lupus Kidney Disease (w/ dialysis) Mental/Nervous disorder Myasthenia Gravis Organ transplant Osteoporosis Stroke Advised surgery/treatment Implantable Cardiac Defib Use of supplemental oxygen Use of a nebulizer Asthma with 3+ medications

Common Conditions & Causes for Denial of Medigap Coverage

Aids
ALS (Lou Gehrig’s Disease)
Alcohol/Drug abuse
Dementia
Chronic Bronchitis
COPD
Cystic Fibrosis
Cirrhosis
Congestive Heart Failure
Diabetes
Emphysema
End Stage Renal Disease
Fibromyalgia
Heart Disease
Hepatitis
Immune Disorders
Multiple Sclerosis
Lupus
Kidney Disease (w/ dialysis)
Mental/Nervous disorder
Myasthenia Gravis
Organ transplant
Osteoporosis
Stroke
Advised surgery/treatment
Implantable Cardiac Defib
Use of supplemental oxygen
Use of a nebulizer
Asthma with 3+ medications

Medigap Open Enrollment Period

It’s important to understand the Medigap Open Enrollment Period as Medigap rights may depend on when an individual enrolls in Medicare Part B. For those over 65, their Medigap Open Enrollment Period begins when they enroll in Part B and continues for 5 months following enrollment. This period cannot be changed or repeated. So, in most cases, it makes sense to purchase a Medigap policy when first eligible for Medicare.

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6 MOS. AFTER ENROLL IN PART B AGE 65+

During their Open Enrollment Period, individuals can get any Medigap policy offered in their state without answering health questions.

Medigap insurance companies are generally allowed to use medical underwriting to decide whether or not to accept the application and how much to charge for the plan. However, during the Open Enrollment Period, applicants can purchase any policy at the price set for individuals in good health, regardless of current issues or pre-exisiting conditions.

Guaranteed Issue (GI) Rights

Guaranteed issue rights provide the opportunity to get a Medigap plan outside of Open Enrollment without health questions.

Guaranteed issue rights (also called “Medigap protections”) are exceptions granted to Medigap applicants under certain circumstances. For instance, those new to Medicare or losing their current coverage may qualify for a guaranteed issue right. In these situations, an insurance company:

Must sell a Medigap policy to an applicant
Must cover all pre-existing health conditions
Can’t charge more for a Medigap policy because of past or present health problems

State Specific Medigap Enrollment Periods

New York + Connecticut (Year Round OE)
Any plan, any carrier, any time. The client does not have to be on a Medicare suppliment for the rule to apply.

California + Oregon (Annual Birthday)
Must apply within 30 days before to 30 days after Birthday. Coverage cannot start until after the birthday.

Maine (Annual OE)
Can switch carriers or plan with equal or lesser benefits. Current Medigap must be in force for at least 90 days.

Missouri (Annual OE)
Must apply within 30 days prior or 30 days after the policy anniversary date. Can go to the same plan only.

Vermont (Year-Round OE for Certain Carriers)
Only for Mutual of Omaha and United Health Care

Washington (GI Rule)
Non-Plan A Medigap plans can change to any other Medigap plan. Plan A must stay on Plan A.

INDIVIDUALS ARE GRANTED A GUARANTEED ISSUE RIGHT IF:
They’re in a Medicare Advantage Plan, and their plan is leaving Medicare or stops giving care in their area, or they move out of the plan’s service area.
They 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.
They have Original Medicare and a Medicare SELECT policy. They move out of the SELECT policy’s service area.
They joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when they were first eligible for Medicare Part A at 65, and within the first year, they want to switch to Original Medicare. (Trial Right)
They dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, they’ve been in the plan less than a year, and they want to switch back. (Trial Right)
Their Medigap insurance company goes bankrupt and they lose your coverage, or their Medigap policy coverage otherwise ends through no fault of their own.
They leave a Medicare Advantage Plan or Medigap policy because company hasn’t followed rules, or misled them.

Medicare Supplement Enrollment

Enrolling in Medigap

Medigap Open Enrollment Period

Guaranteed Issue (GI) Rights

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