Medigap Eligibility
Who can enroll in Medicare Supplement insurance, when to enroll, and what happens if you miss your window.
Speak with a Licensed AgentWho Is Eligible for Medigap?
To purchase a Medicare Supplement (Medigap) policy, you must meet a few basic requirements. Federal law establishes the minimum eligibility rules, though some states have additional protections.
Enrolled in Medicare Part a and Part B
You must be enrolled in both Medicare Part A (hospital) and Part B (medical) to purchase a Medigap policy.
Age 65 or Older (or Qualifying Disability)
Most people become eligible at 65. If you're under 65 and have Medicare due to a disability, some states require insurers to sell you Medigap, but federal law doesn't guarantee it.
Not Enrolled in Medicare Advantage
You cannot have both a Medigap plan and a Medicare Advantage plan at the same time. If you want Medigap, you must use Original Medicare (Parts A and B).
U.S. Resident
You must reside in the United States. Medigap plans are sold state by state, and your premium is based on your state of residence.
The Medigap Open Enrollment Period
The Medigap Open Enrollment Period (OEP) is the most important window for enrolling in a Medigap plan. During this 6-month period, you have guaranteed issue rights - meaning insurers must sell you any Medigap plan they offer, regardless of your health history.
Your 6-Month Window
- When it Starts
- The month you turn 65 AND are enrolled in Medicare Part B
- Duration
- 6 months (cannot be extended or repeated)
- What it Guarantees
- The right to buy any Medigap plan sold in your state, regardless of health
- Medical Underwriting
- None - insurers cannot deny coverage or charge higher premiums due to pre-existing conditions
- What Happens After
- Insurers can use medical underwriting and may deny coverage or charge more
Guaranteed Issue Rights
Outside of your OEP, you may still have guaranteed issue rights in specific situations. In these cases, insurers must sell you a Medigap plan without medical underwriting.
Your Medicare Advantage plan is leaving your area or stops covering your area
You move out of your Medicare Advantage plan's service area
Your employer-sponsored health plan is ending
Your Medigap insurer goes bankrupt or loses its license
You enrolled in Medicare Advantage when first eligible and want to switch back within 12 months
You have a Medicare SELECT plan and move out of the service area
In most guaranteed issue situations, you have 63 days from losing your previous coverage to enroll in a Medigap plan.
What Is Medical Underwriting?
Medical underwriting is the process insurers use to evaluate your health history before deciding whether to sell you a Medigap plan and at what price. Outside of your OEP and guaranteed issue situations, insurers can:
- Deny your Medigap application entirely
- Charge higher premiums based on your health history
- Exclude pre-existing conditions from coverage for up to 6 months
Common conditions that may affect underwriting include heart disease, diabetes, COPD, cancer, stroke, kidney disease, and other chronic conditions. Each insurer has its own underwriting guidelines.
Frequently Asked Questions
Ready to Enroll in Medigap?
Our licensed Medicare agents can help you understand your eligibility, find the right plan, and enroll during your Open Enrollment Period - at no cost to you.