Eligibility Requirements for Medicare Supplement Insurance

Medicare Supplement Insurance (also called Medigap) can help you save money by covering some out-of-pocket Medicare costs. These costs can include Medicare copayments, coinsurance and deductibles.

Here is an overview of Medicare Supplement Insurance eligibility requirements, along with some information about how to find the right Medigap plan for you and how to enroll.

Man at the pool

Am I eligible for Medicare Supplement Insurance?

There are four main requirements to be eligible for Medicare Supplement Insurance enrollment.

You must be enrolled in both Part A and Part B of Medicare

Medicare Supplement Insurance provides coverage for some of the out-of-pocket expenses associated with Original Medicare (Part A and Part B), such as deductibles and coinsurance. You must be enrolled in both parts of Original Medicare in order to apply for a Medigap plan.

You must live in an area in which your desired plan is sold

Medicare Supplement Insurance is sold by private insurance companies, and the availability of plans can vary from one state to another. You are only eligible to enroll in plans that are offered in the area in which you reside.

MedicareSupplement.com can help you compare plans that are available where you live.

In some states, you may not be eligible if you are under 65 years old

People under 65 years can be eligible for Original Medicare if they have a qualifying condition or disability. But only certain states require insurance companies to sell Medicare Supplement Insurance to people under the age of 65.

The following states require insurance companies to offer at least one Medigap plan to Medicare beneficiaries under 65:

  • California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont and Wisconsin.

You must not currently be enrolled in a Medicare Advantage plan

Medicare Advantage plans (Medicare Part C) are an alternative to Original Medicare, offering the same benefits as Medicare Part A and Part B in one single plan.

If you are enrolled in Medicare Advantage, you will not be eligible to sign up for a Medicare Supplement Insurance plan. You must disenroll from your Medicare Advantage plan before you can join a Medigap plan.

Medicare Supplement Insurance Plans 2019
Medicare Supplement Benefits A B C D F1 G K2 L3 M N4
Part A co-insurance and hospital costs
Part B co-insurance or co-payment 50% 75%
First 3 pints of blood 50% 75%
Part A hospice care co-insurance or co-payment 50% 75%
Co-insurance for skilled nursing facility     50% 75%
Medicare Part A deductible   50% 75% 50%
MedicarePart B deductible              
Medicare Part B excess charges              
Foreign travel emergency     80% 80% 80% 80%     80% 80%
1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

When can I enroll in a Medigap plan?

Your Medicare Supplement Insurance plan eligibility can be impacted on when you choose to apply for a plan.

The best time to apply is during your Medigap open enrollment period. Your six-month Medigap open enrollment period begins once you are 65 years old and enrolled in both Part A and Part B of Medicare.

If you sign up for a plan during this period, insurance companies are not allowed to use medical underwriting to determine your premiums. This means that they cannot charge you more for a plan based on your age or your health.

If you apply for a plan outside of your Medigap Open Enrollment Period, the provider may use your health to determine your plan premium rates, and they even reserve the right to deny you Medigap coverage altogether.

Medicare Supplement Insurance Special Enrollment Periods

There are some special enrollment periods for Medicare Supplement Insurance, though you have to meet specific criteria to qualify for one of these special enrollment periods.

If one of the following situations applies to you, you may qualify for a Medigap special enrollment period:

  • You received a Medicare Supplement Insurance plan through your employer, and that coverage ended.

  • You belong to a Medicare Advantage plan, and the plan stops serving your area or you move out of the plan’s service area.  

  • You have a Medicare SELECT plan, and you move out of the plan’s service area.

  • You joined a Medicare Advantage plan or PACE when you first became eligible, and you decided to leave the plan within one year of enrolling.

  • You dropped a Medigap plan in favor of a Medicare Advantage or Medicare SELECT plan, and you wish to switch back to a Medigap plan within one year.

  • You are enrolled in a Medigap plan, and the plan ends through no fault of your own.

  • You are enrolled in a Medicare Advantage or Medigap plan provided by a company that misled you or was found to have not followed certain regulatory rules.

Finding the right Medicare Supplement Insurance plan for you

If you have any further questions about your Medicare Supplement Insurance eligibility and how to enroll in a Medigap plan, you can learn more by visiting Medicaresupplement.com today.

Copyright 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.