Medicare Supplement Insurance, commonly referred to as Medigap, is designed to help cover the out-of-pocket costs not paid by Original Medicare. These costs may include deductibles, copayments, and coinsurance. While Medigap policies can offer significant benefits for managing healthcare expenses, not everyone qualifies automatically. Understanding eligibility rules is essential before applying for a plan.
The first requirement for Medigap eligibility is enrollment in both Medicare Part A and Part B. Medigap is not available to those enrolled in Medicare Advantage (Part C), as Advantage plans already provide an alternative to Original Medicare and typically have their own structure for out-of-pocket costs. Individuals must be enrolled in Original Medicare to be eligible for a Medigap plan.
The best time to apply for a Medigap policy is during the Medigap Open Enrollment Period. This six-month window begins on the first day of the month in which a person turns 65 and is also enrolled in Medicare Part B. During this period, insurance companies are required to sell any available Medigap plan regardless of health status or preexisting conditions. Coverage is guaranteed, and premiums are not based on medical history.
Outside of this enrollment window, individuals may still apply for a Medigap plan, but eligibility becomes subject to medical underwriting. This means insurance companies can require health screenings, evaluate medical history, and may charge higher premiums or even deny coverage based on certain conditions. For this reason, applying during the Medigap Open Enrollment Period is considered the most advantageous time to secure coverage.
Certain life events can trigger guaranteed issue rights, which allow enrollment in Medigap without underwriting even outside the initial enrollment window. These include situations such as losing employer-sponsored coverage, a Medicare Advantage plan discontinuing service in an area, or moving out of the service area of a current plan. In these cases, individuals may be eligible to purchase select Medigap plans without medical underwriting, typically within 63 days of losing prior coverage.
Individuals under the age of 65 who qualify for Medicare due to disability face different rules depending on state regulations. In Louisiana, some Medigap insurers offer plans to individuals under 65, but availability, plan types, and premium costs can vary significantly. These individuals often experience a second open enrollment period upon turning 65, at which point they may be eligible for a broader range of Medigap options at standard rates.
Another factor in eligibility is the timing of enrollment in Medicare Part B. Individuals who delay Part B enrollment—often because they have employer-based coverage—will begin their six-month Medigap Open Enrollment Period once they are officially enrolled in Part B. The same protections apply at that point, regardless of age.
Medigap policies are individual plans, which means each spouse must apply separately. Joint or family coverage is not available under Medigap. Each plan is tailored to the individual, and premiums are calculated accordingly.
Medigap plans are standardized, meaning benefits are the same regardless of the insurer, but availability can vary by state and provider. Plans are labeled A through N, each offering different combinations of coverage. Not all plans are available in every area, and some may be phased out for new enrollees. For example, Plans C and F are not available to individuals newly eligible for Medicare after January 1, 2020.
Prescription drug coverage is not included in Medigap plans. Those seeking drug coverage must enroll in a separate Medicare Part D plan. It’s important to enroll in a Part D plan on time to avoid late enrollment penalties and maintain consistent coverage for medications.
Medigap policies also do not cover services such as dental, vision, hearing aids, or long-term care. Supplemental plans are focused specifically on costs related to Medicare-approved services and are not intended to serve as comprehensive insurance.
When evaluating Medigap options, it is helpful to understand how pricing models work. Some insurers offer community-rated plans, where all enrollees pay the same rate regardless of age. Others use issue-age or attained-age rating, which may result in higher premiums over time. Comparing pricing structures is part of determining long-term affordability.
Understanding eligibility for Medigap coverage involves multiple factors: age, Medicare enrollment status, health history, timing, and life circumstances. The six-month Medigap Open Enrollment Period remains the most secure time to obtain a policy, but guaranteed issue rights provide additional protections in specific situations.
ADDvantage Insurance works with individuals across Louisiana to evaluate Medigap eligibility, clarify enrollment timing, and compare policy options. With access to multiple insurance carriers, a wide range of plans can be reviewed based on budget, coverage needs, and geographic availability.
Navigating Medicare and Medigap eligibility can feel complex, especially when rules vary by age, health status, and state. Understanding when and how to enroll is key to avoiding coverage gaps and limiting out-of-pocket healthcare costs. Medigap provides a valuable layer of financial protection—but it begins with knowing who qualifies and when to act.
For those approaching 65, reviewing current coverage and identifying the Medigap Open Enrollment window should be a top priority. Individuals already on Medicare should evaluate if any guaranteed issue rights apply to their situation. Staying informed about eligibility rules ensures that the right decisions are made at the right time to secure effective supplemental coverage.
