What it is
Medigap eligibility means the conditions you generally need to meet to buy a Medigap plan. Medigap is also called Medicare Supplement insurance. It is sold by private companies and may help with some costs that Original Medicare does not pay.
The first requirement is usually having both Medicare Part A and Part B. Medigap works with Original Medicare. It is not designed to be paired with a Medicare Advantage plan.
Which plan letters you can buy depends on when you became eligible for Medicare. Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans C and F (and high-deductible F) are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. Massachusetts, Minnesota and Wisconsin standardize Medigap differently.
How it’s traditionally been approached
Many people look at Medigap when they first enroll in Medicare Part B. For many, this starts around turning 65. Many states have a Medigap open enrollment period during that time. During it, a company generally cannot use your health history to decide whether to accept you.
Outside that window, rules differ. In many cases a company may use medical underwriting, which means it can review your health history. Some situations offer guaranteed issue rights, such as certain changes in other coverage. These rights, and the timing around them, vary by state and change over time.
Some people under 65 who have Medicare may also look at Medigap. Access for them depends on the state and the company. Others who leave a Medicare Advantage plan wonder if they can switch. Many people confirm the current rules with Medicare.gov, their State Health Insurance Assistance Program (SHIP), or a licensed agent.
How the right licensed agent may help
A Medigap agent is a licensed professional who may help you understand whether you are likely to qualify and when. They can explain how your Part B start date, your state and your situation may affect your options. This is education, not a promise of acceptance.
A conversation is generally relaxed. An agent may ask about your Medicare start date, your current coverage, your doctors and your state. They may then explain how plans such as Medigap Plan G or Medigap Plan N are generally structured, and which carriers sell in your area.
Good questions to ask: Is my open enrollment window still open? Might I face medical underwriting? Do I have any guaranteed issue rights? How do my drug coverage and Part D fit in? How does Medigap compare with Medicare Advantage for my needs? Call 1-800-MEDIGAP for more information.
The bigger picture
Health insurance choices can feel heavy. Timing rules can add worry, especially if you fear missing a window. Knowing the basics early may bring some calm and help you plan around your health and your budget.
Peace of mind often comes from feeling informed and unhurried. Taking time to ask questions, and involving family you trust, can support both your finances and your wellbeing. If you also need help finding care, Providers.plus may be a useful resource.
Keep in mind
- Eligibility rules, open enrollment periods and guaranteed issue rights vary by state and change over time. Confirm them with Medicare.gov, your SHIP, or a licensed agent.
- Medigap generally requires Part A and Part B. It is not meant to be used with a Medicare Advantage plan.
- Medigap has trade-offs. It offers any provider nationwide that accepts Medicare, no networks or referrals, and predictable cost-sharing. Premiums are generally higher, medical underwriting may apply, drugs need a separate Part D plan, and routine dental, vision and hearing are not included.
- Medicare Advantage has strengths too, such as often lower premiums, an annual out-of-pocket maximum, extra benefits and drug coverage in many plans. Its trade-offs include networks, prior authorization and copays. 1-800-MEDIGAP is independent educational information, not insurance, legal, tax or medical advice.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
What is Medigap eligibility?
Medigap eligibility is the set of conditions for buying a Medigap plan. Generally, you need Medicare Part A and Part B. Timing, state rules and your health history may also matter.
Do I need Medicare Part B to qualify for Medigap?
Yes, Medigap generally requires both Part A and Part B. Medigap works with Original Medicare. Confirm details with Medicare.gov, your SHIP, or a licensed agent.
Can I be turned down for a Medigap plan?
It depends on timing and state rules. During open enrollment or with guaranteed issue rights, companies generally cannot use your health history. Outside those windows, medical underwriting may apply, and acceptance is never guaranteed.
Which Medigap plans can I buy if I am new to Medicare?
Newly eligible people can generally buy Plans A, B, D, G, K, L, M and N, plus high-deductible Plan G. Plans C and F, and high-deductible F, are only for those who became eligible before January 1, 2020. Plans E, H, I and J were discontinued, so Plan H is not sold today.
Can I buy Medigap if I am under 65?
Sometimes, but it depends on your state and the company. Some states require that insurers offer plans to people under 65 with Medicare, and others do not. Check current rules with your SHIP or a licensed agent.
Is 1-800-MEDIGAP part of Medicare?
No. 1-800-MEDIGAP is an independent, privately run educational directory. It is not Medicare.gov, CMS, Social Security or any government agency, and it is not endorsed by the U.S. government. Official information is at Medicare.gov. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.