Medicare Supplement Eligibility

All Medicare beneficiaries who are enrolled in Part A and Part B of Original Medicare are eligible to apply for a Medicare supplement. However, you may need to pass medical underwriting to be issued one of these policies.

If you are applying during your Initial Enrollment Period, you are eligible to choose any Medicare supplement without answering health questions. Your IEP is a window of time around either your 65th birthday or when you enroll in Medicare Part B.

Common Underwriting Questions

Each insurance company has its own set of eligibility requirements. Some carriers are less strict than others, but generally speaking, their medical underwriting processes are similar. A few common questions include:

● In the past several years, have you had cancer, a heart attack, or a stroke?
● Do you have COPD (Chronic Obstructive Pulmonary Disease)?
● Do you have diabetes that requires you to take more than 50 units of insulin per day?
● Have you recently been hospitalized?
● Do you have any pending test results or scheduled surgeries?

If you answer yes to any of these questions, you will likely be denied access to a Medicare supplement plan. In addition, many carriers have a list of prescriptions they use as part of their health questionnaire. If you are currently taking a prescription drug on their list, they will likely deny coverage.

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Guaranteed Issue Situations

Outside of your Initial Enrollment Period, there are some situations when you have limited guaranteed issue rights. The following is a list of times when you may qualify for a Medicare supplement without medical underwriting:

● You join a Medicare Advantage (Part C) plan for the first time and decide to switch to a Medicare supplement within the first year of coverage. (This is called Trial Right.)
● Your current Medicare Advantage plan leaves your coverage area.
● You move away from your Medicare Advantage plan’s network area.
● You move away from your Medicare SELECT service area.
● You lose your employer coverage.
● Your current insurance company misled you or broke Medicare rules.
● Your current insurance company files bankruptcy.

In these situations, you will usually only have the rights to certain Medicare supplement plans. For example, if you had a Medicare supplement and chose to switch to Medicare Advantage for the first time, you can use your Trial Right to switch back to a supplement. However, you’ll only be eligible for the same plan with the same insurance company as you had prior to switching. If you did not have a Medicare supplement in the past, you might be free to choose insurance companies, but be limited on which letter-plan you can have.

Lastly, some states have their own rules pertaining to medical underwriting. There are five states that allow you to switch to a plan of equal or lesser value around your birthday and others that have no medical underwriting year-round but with specific limitations.

Medigap Eligibility

Be 100% honest on your Medicare Supplement insurance applications.

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To switch Medicare Supplements you must be able to answer health questions --unlike Advantage plans

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FAQ

Can I Get a Supplement if I have Diabetes?

Typically Yes, diabetes is only a disqualifier for many companies if you have complications or take above a certain threshold of insulin.

Summary

In order to be eligible for a Medicare Supplement plan, you will either have to pass health underwriting or have a situation that allows you to skip underwriting. For most people, their only chance to get a medigap plan is during their open enrollment period when they are new to Medicare. Want to shop your Medicare Supplement? Schedule an appointment with us to compare the plans and prices in your area.

Sylvia Gordon, aka Medicare Mama^®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare^®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.

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