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Who Is Eligible for a Medicare Supplement Insurance Plan?

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Medicare Supplement insurance plans are sold by private health insurance companies, but unlike some other health plans sold by private insurers, Medicare Supplement insurance plans may have eligibility requirements in some situations.

Medicare Supplement insurance plans eligibility with Original Medicare

Medicare Supplement insurance plans are intended to work with Original Medicare (Medicare Part A and Part B). To be eligible for a Medicare Supplement insurance plan, first enroll in Medicare. Medicare Part A and Part B are generally available to citizens of the USA or permanent legal residents for at least five continuous years who have any one of the following qualifications:

  • Aged 65 and older
  • Diagnosed with end stage renal disease (ESRD – permanent kidney failure requiring dialysis or transplant)
  • Receiving disability benefits from the Social Security Administration or the Railroad Retirement Board. Generally you’re eligible for Medicare after receiving disability benefits for 24 months in a row.
  • Diagnosed with Lou Gehrig’s disease (ALS).

You may be automatically enrolled in Medicare Part A when you turn 65 and it’s premium-free for most people who have worked 10 years or more and paid Medicare taxes. In most cases, you’re also automatically enrolled in Medicare Part B, but pay a monthly premium for it.

What age are you eligible for Medicare Supplement insurance plan?

In most states, one requirement for Medicare Supplement eligibility may be age. Federal law doesn’t require insurance companies to sell Medicare Supplement insurance plans to people under 65. If you have ESRD, you may not be able to buy the Medicare Supplement insurance plan you want, or any policy, until you turn 65. However, many states require insurance companies to offer at least one kind of Medicare Supplement insurance plan to people under 65 with Medicare.

Medicare Supplement insurance plan eligibility for people under 65

In some states, insurance companies may voluntarily sell Medicare Supplement insurance plans to people under 65, even though they are not federally mandated to do so. The insurance policies might cost more than the plans sold to people 65 and over, and the insurance company may be able to use medical underwriting (evaluating your health conditions in order to make policy decisions). This means that any health condition could result in a premium increase.

You can apply for a Medicare Supplement insurance plan anytime once you’re enrolled in Medicare Part A and Part B – you’re not restricted to certain enrollment periods as you are with other Medicare enrollment options. However, there are only certain periods or situations when you have guaranteed issue rights to enroll in a Medicare Supplement insurance plan. One such period is described below.

Medicare Supplement Open Enrollment Period

If you are 65 or older, you may be able to purchase Medicare Supplement insurance plan during the Medicare Supplement Open Enrollment Period. This period lasts for six months and begins on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B. During this period, you can buy any Medicare Supplement insurance plan the insurance company sells without the risk of being turned down or charged more because of a health condition. In some cases, a waiting period might apply. The practice of medical underwriting is what insurers use to evaluate health conditions when making policy decisions. During this Open Enrollment, medical underwriting cannot be used. Outside of this Open Enrollment Period, health problems and pre-existing conditions* may compromise your Medicare Supplement eligibility or make you pay more for a policy.

Once you have a Medicare Supplement insurance plan, you must continue to pay your monthly premiums to maintain coverage (as well as your Medicare Part B premium). Medicare does not cover any Medicare Supplement premium costs.

Here are some reasons you may be turned down from a Medicare Supplement insurance plan or pay a higher premium:

  • You have Medicare but you’re under 65
  • You’re 65 but haven’t enrolled in Medicare Part B
  • You have a health problem and your Medicare Supplement Open Enrollment Period has ended

*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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