Eligibility

Who can buy Medigap?

Everyone who has both Medicare Parts A and B can buy a Medigap policy. In most states, it is usually easier to buy a Medigap policy when you are age 65 or older. Some states also require insurance companies to sell Medigap policies to people under 65 who have Medicare.

Sometimes, insurance companies must sell you a policy, regardless of your current health. At other times, companies can refuse to sell you a policy. Or, they can make you wait up to 6 months before your coverage starts. This is called a pre-existing waiting period. Companies also can charge you more because of your health problems. This may happen when you apply for a new policy or switch from another Medigap policy.

At some times, companies can require medical underwriting for your policy.

What is medical underwriting?

Companies that sell Medigap policies are allowed to review your medical history before they sell you a policy. This is called medical underwriting. The information you give about your health must be true and complete. If it is not, your policy could be cancelled later on. And, you may have to pay for all past claims.

Note: The only time an insurance company cannot medically underwrite you is when you turn 65 and are signed up for Medicare Part B. This is called your Medigap Open Enrollment Period. It is a 6-month period to buy a Medigap policy. It is the best time to buy one. You only get one Open Enrollment Period, so be sure not to miss it.

Learn more your rights to buy a Medigap policy without being subject to medical underwriting.

What if I am age 65 or over?

During your Medicare Open Enrollment Period, insurance companies must sell you a Medigap policy, regardless of your health. They cannot medically underwrite you.

To get a Medigap at this time, they cannot make you:

  • Fill out a medical questionnaire, or
  • Answer medical questions, or
  • Let them talk to your doctor, or
  • Take a medical exam.

This Medigap Open Enrollment Period only lasts for 6 months. It begins on the first day of the month in which you are both at least 65 andenrolled in Medicare Part B. Once this time has passed, you will not get the chance again to get a Medigap without underwriting.

Note: During the 6 months before your Open Enrollment Period, you may have had other health coverage. This is called “creditable coverage.” If so, you will not have to wait to get covered by a Medigap policy. They cannot put a waiting period on your coverage start date.

But, if you did not have coverage before this, you may have to share your medical history with the insurance company. You can still get a Medigap plan. But you may have to wait before the plan will cover any health issues that were diagnosed and/or treated during the 6 months before your Open Enrollment Period.

What if I am under age 65 and live with a disability?

If you are getting Medicare because you get Social Security Disability Insurance benefits, you may be able to find an insurance company that will sell you a Medigap policy. This depends on where you live.

Some states require plans to offer coverage for people on Medicare who have disabilities. Others do not. And in most states, those that do are allowed to medically underwrite you, or charge more because of your health problems.

Find out more about the rules in your state. Use the state insurance department locator to find and contact someone in your state.

Still have questions? Get personal help.

Note: If you have Medicare because of a disability, you will get a Medigap Open Enrollment Period when you turn age 65. Your health status does not matter.

NEXT: Choosing a Medigap Policy – 5 Simple Steps

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