Medicare Supplement (Medigap) Eligibility

Insurance companies that offer Medicare Supplement policies in Wisconsin are required to sell their Medicare supplement and Medicare select policies to beneficiaries regardless of age or disability, during the six month window beginning with the date an individual begins Medicare Part B. During this six-month open-enrollment period, insurance companies may not deny or condition the issuance of a policy on health status, claims experience, receipt of health care, or medical condition.  

If a policy is purchased outside of a beneficiaries open enrollment, insurers can uphold a waiting period before preexisting health conditions are covered unless the beneficiary had prior "creditable coverage." In addition, if an individual is under age 65 and in Medicare due to disability or end stage renal disease, the beneficiary will be entitled to a second six-month open-enrollment period upon reaching age 65. 

The insurance company must quote a Medicare Supplement policy with out medical underwriting if: 

• The Medicare Advantage or Medicare cost plan stops participating in Medicare or providing care in the beneficiary's service area; 
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• The beneficiary moves outside a plan's geographic service area; 
  
  
• The beneficiary leaves the health plan because it failed to meet its contract obligations; 
  
  
• The employer group health plan ends some or all of their healthcare coverage (not of the beneficiary’s own choice); 
  
  
• The Medicare supplement insurance company ends the Medigap or Medicare select policy and the beneficiary is not at fault (for example, the company goes bankrupt); 
  
  
• The beneficiary drops their Medigap policy to join a Medicare Advantage plan, a Medicare Cost plan, or Medicare select policy for the first time, and then the beneficiary leaves the plan or policy within the first 12 months after joining. However, they may only return to the policy under which originally covered, if available; or will get Guarantee Issue to purchase any Medicare supplemental policy; 
  
  
• The beneficiary enrolls into a Medicare Advantage plan when starting Medicare at age 65 and within 12 months they decide to disenroll from that plan;
  
  
• The beneficiary has Medicare Parts A and B and are covered under Medical Assistance and subsequently loses eligibility for Medical Assistance;
  
  

• The beneficiary's group plan increases its (premium) cost from one 12-month period to the next (12 month period) by more than 25% and the new payment for the employer-sponsored coverage is greater than the premium charged under the Medicare Supplement plan the individual is applying for;

  
  

•  The beneficiary lost Medicaid eligiblity. ​
  

The insurance company terminating coverage must provide notification that explains individual rights to guaranteed issue of Medigap policies. A copy of this notice (creditable coverage) or other evidence of termination will need to be submitted with the application for the new policy.