Medicare Supplement – Frequently Asked Questions

Anyone who is covered under both Medicare parts A and B is eligible for Medigap Coverage.

You can apply for Medicare Supplement Insurance during open enrollment. Open enrollment includes a six-month period from the date you enrolled in Medicare Part B if age 65 or older, or up to six-month after you turn 65 if you were eligible for Part B benefits before age 65. If you become eligible for Medicare Part B benefits before age 65 because of disability or ESRD (permanent kidney failure), you are guaranteed the Medicare Supplement policy of your choice during the first six months you are age 65 and enrolled in Part B.

California has a unique law that gives Medicare Supplement (Medigap) policyholders a special annual enrollment opportunity. During a 30-day window beginning on your birthday each year, you may switch to any Medicare Supplement plan with equal or lesser benefits from any insurance carrier — without medical underwriting, health questions, or risk of being denied coverage due to pre-existing conditions.

Key points:

• The window opens on your birthday and lasts 30 days
• You can switch to a plan with equal or lesser benefits (e.g., Plan G to Plan G, or Plan G to Plan N)
• Insurers cannot deny coverage or charge higher premiums based on your health status
• This right applies to California residents only
• You must already be enrolled in a Medicare Supplement plan to qualify

This is an excellent opportunity to shop for a lower premium every year without risking your coverage.

No. The California Birthday Rule only allows you to switch to a plan with equal or lesser benefits. You cannot use it to move to a plan with more benefits (for example, switching from Plan N to Plan G is not permitted under this rule). To upgrade your benefits, you would need to go through full medical underwriting and could potentially be denied based on your health history.

No, Medicare Supplement is designed to fill in the “gaps” with Medicare Plans such as Part A (which covers hospital and skilled nursing facility care) and Part B (which covers doctor bills and other medical expenses). For prescription drug coverage, you can select a separate Medicare Part D Prescription Drug Plan.

No, you must be entitled to Medicare Part A and/or enrolled in Medicare Part B to be eligible for a Medicare prescription drug coverage.

Not everyone needs a Medicare supplement policy. If you have certain other types of health coverage, the gaps in your Medicare coverage may already be covered. You probably don’t need Medicare supplement insurance if
• you belong to a Medicare Advantage plan
• Medicaid or the Qualified Medicare Beneficiary (QMB) Program pays your Medicare premiums and other out-of-pocket costs.
• You are covered under an employer group health plan

Check with your group plan administrator. You may be able to choose either your group plan or Medicare plus Medicare Supplement coverage. If you stay with your group health care plan, a Special Enrollment Period lets you delay purchasing Part B until you need it.

No, you may continue to see your own doctor. Medicare Supplement plans are convenient and flexible, giving you freedom of choice.

Yes. Just remember that your out-of-pocket costs will be less if you choose a physician who accepts Medicare assignment.