Medicare Questions & Answers: Eligibility

Eligibility Q&A

Showing 12 questions

Answered by Lea Ayres Medicare Insurance Agent

Lea Ayres

MediConnect • Pittsburgh, PA

I'm retiring next year - do I need to do anything with my Medicare?

If you're retiring next year and turning 65, you'll need to sign up for Medicare (Part A and Part B) through Social Security, either online or by contacting your local office, to avoid potential gaps in coverage or penalties.
Answered by Shawn Brown Medicare Insurance Agent

Shawn Brown

Shawn E Brown Insurance • Daytona Beach, FL

Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?

In most cases, yes, you will have to answer health questions when switching from one Supplemental/Medigap plan to another. However, there are certain situations where you may qualify for guaranteed issue rights, which means you can switch plans without having to answer medical questions or go through underwriting.

Guaranteed issue rights typically apply if you’re losing other coverage, moving out of your plan’s service area, or switching within your Medigap trial period, among other special circumstances. It’s always best to review your specific situation to determine whether you qualify for guaranteed issue or if underwriting will be required.
Answered by Sean Davis Medicare Insurance Agent

Sean Davis

Davis Care Insurance Services Inc • Brooklyn, NY

Am I eligible for a Special Enrollment Period if I lose employer coverage?

Yes, you may be eligible for a Special Enrollment Period (SEP) if you lose your employer health coverage. This SEP typically lasts for 8 months following the loss of your coverage, allowing you to enroll in Medicare without facing penalties. It's important to inform Medicare of your loss of coverage to ensure a smooth enrollment process
Answered by Nicole Creamer Medicare Insurance Agent

Nicole Creamer

Nicole Creamer Insurance Services • Omaha, NE

Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?

The short answer is no. However, there are always exceptions such as a Special Enrollment Period (SEP) to make a change or within your 12-month trial right period, or you are involuntarily terminated from your Medicare Advantage plan due to moving out of the plan service area, gaining eligibility due to age (turning 65), to name a few. In these cases, I want to discuss the change and ensure we cover all available SEP options.
Answered by Larry Dalton Medicare Insurance Agent

Larry Dalton

D&D Ins. Group, LLC • Durant, OK

What if I missed my window to sign up?

There are various circumstances and specific conditions to consider before providing a final answer to this questionnaire. Most likely, penalties will apply if you miss your initial enrollment window for Medicare’s Parts A, B, or D. A Medicare health insurance agent can review your situation and provide you with the necessary details.
Answered by Brian Moore Medicare Insurance Agent

Brian Moore

Ohio Medicare Plan • Dayton, OH

What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?

When clients ask about Guaranteed Issue for Medicare Supplement plans, I explain it’s a right that stops insurers from denying coverage or raising rates due to pre-existing conditions. It applies during your initial enrollment at 65—starting the first day of your birthday month and lasting six months—or within 63 days of losing qualifying coverage, like an employer plan, or during your 12-month trial period if you’re new to Medicare Advantage and switch back to Original Medicare. For folks under 65 with disabilities, federal law doesn’t guarantee it, but many states offer a similar six-month window when you enroll in Part B. Missing these windows usually means facing medical underwriting.
Answered by Brian Moore Medicare Insurance Agent

Brian Moore

Ohio Medicare Plan • Dayton, OH

Who qualifies for Medicare coverage if they are under 65?

If you’re under the age of 65 and have a disability, you may qualify for Medicare coverage. A qualifying disability is almost any health condition that prevents you from being able to work enough to access employer-sponsored health care benefits. Before you can enroll in Medicare, you must receive Social Security Disability Insurance for two years. If you have end-stage renal disease or amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease, that 24-month waiting period is waived.
Answered by Larry Dalton Medicare Insurance Agent

Larry Dalton

D&D Ins. Group, LLC • Durant, OK

I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?

No. To be eligible as a green card holder, you must live in the United States for five years before applying for Medicare.
Answered by Melonie Wood Medicare Insurance Agent

Melonie Wood

American Senior Benefits • Westville, FL

If I have been on disabilty due to an accident, do I qualify for Medicare Insurance?

If you re on disability for 24 months, you qualify for disability. Medicare will hold back 6 months to see if the disability resolves itself. After 30 months a person on disability will get a Medicare Card
Answered by Cleo Martin Medicare Insurance Agent

Cleo Martin

Licensed Agent • Myrtle Beach, SC

I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?

Medicare and a Medicare supplement are 2 completely different things. Medicare is what you paid into. A Medicare supplement is from a private insurance company. They have underwriting questions that you have to be able to answer correctly or they can deny you. They are completely separate things. The supplement works with Medicare to pay what Medicare doesn't pay. Medicare is what you paid into all these years. A Medicare supplement is something you have to purchase. Different companies have different questions so depending on your health situation, you may or may not be able to by one. Hope this helps explain.

Cleo Martin

803-730-8368
Answered by Joseph Bachmeier Medicare Insurance Agent

Joseph Bachmeier

BGA Insurance Group • Conshohocken, PA

Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?

You will be considered “guaranteed issue” as long as your employer coverage is considered credible coverage, which in most cases it is. There are a few other instances where you can be considered guaranteed issue.