Medicare Questions & Answers: Eligibility
Eligibility Q&A
Showing 13 questions
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.
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.
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
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.
What if I missed my window to sign up?
If you missed your window to sign-up for Medicare you could qualify for a Special Enrollment Period (SEP) , such as when you loose employers insurance (or other reasons). If you do not qualify for a Special Enrollment Period, you can sign up for Medicare Part A and/or Part B during the Open Enrollment Period which runs from January 1 through March 31 each year. Check the medicare.gov website or talk to a Medicare Insurance agent to find out what applies for you and how to go about the application process.
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
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.
If I have been on disabilty due to an accident, do I qualify for Medicare Insurance?
Yes, if someone has been on disability for 24 month or more, they are eligible for Medicare. Once someone has Part A and B in place, we can shop different plan options to ensure they have all of their puzzle pieces in place and have access to the care that they need!
Can Medicare drop me for health reasons?
Medicare can NOT drop you because of health reasons. If you have a Medicare supplemental plan and drop the plan because you want to change to a Medicare Advantage and you are on the Medicare Advantage for more than 12 months you will be asked health questions to go back to a Medicare Supplemental plan and some people can not qualify. Or if you missed a monthly premium and have a lapse of coverage, you may have to answer health questions to get back and you may not qualify.
I'm turning 65 in three months but still working with employer coverage. Do I need to sign up for Medicare right now or can I wait?
You can wait as long as you are maintaining employer coverage. Medicare part A will still get assigned to you but (as long as you are not receiving SS benefits) not part B. When you do choose to leave employer coverage make sure you visit SSA.gov and “apply for Medicare part B only”. Keep in mind this may take at least a few weeks and you may have to collect some signatures from your employers HR dept so start this process at least a month before you plan on quitting/ leaving employer coverage.
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.
What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?
Guaranteed issues for Medicare supplement plans ensure you can purchase a Medicare supplement/Medigap plan that picks up the gaps that Medicare Part A and B leave behind. A guaranteed issue means you do not have to be questioned about your health conditions with the insurance underwriters, and the policy will not be denied. Guaranteed issue applies to the six months around your 65th birthday. Three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday, you have the right to get a guaranteed issue policy for your Medigap plans. After that, there are some special guarantee issues when retiring from a group insurance plan, but that would be for another discussion.
I'm a green card holder who's been in the US for 4 years and turning 65 soon. Am I eligible for Medicare?
You must have lived in the US for a min of 5 years. At that time you will likely have a Premium for Part A as well as the normal Part B premium since you have not lived her and worked at least 40 Quarters.Browse Other Questions & Answers
Coverage (132) Advice for Seniors (107) The Medicare System (80) Medicare Advantage (68) New To Medicare (48) Agent Interview (42) Medicare Part D (42) Prescription Drug (38) Medicare Part B (37) Medicare Supplement (29) Enrollment Periods (19) Medicare Part A (16) Turning 65 (13) Eligibility (13) Social Security (9) Retirement (8) Advice for Caretakers (6) Life Insurance (2) Medicare (1) Medicare Basics (1) Medicare FAQ (1)Have a Medicare Question of Your Own?
Submit your question to our nationwide community of licensed Medicare agents.
We'll only use your email to notify you when a licensed Medicare agent answers your question.