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Can I Get Medicare Supplement If I Lost Group Health Coverage?

If you're Medicare-eligible and lose group health coverage, you may still be able to enroll into a Medigap or Medicare supplement plan. The deciding factors include when you enrolled into Medicare Part B and whether or not you meet the insurance company's underwriting guidelines. Even if you can't qualify for Medigap, you may be eligible for other coverage, like a Medicare Advantage plan.

  1. Medicare and Group Coverage

    • You're entitled to Medicare Parts A and B when you turn 65, as long as you've worked and paid into Social Security the minimum amount of time required to qualify: 40 quarters. Part A covers hospitalization, while Part B covers other medical services, including doctor visits. Part A has no additional premium, so even if you have group coverage, you should still accept Part A. Part B has an additional premium, and if you have group coverage, whether it's through your employment or a spouse, consider delaying enrolling in Part B.

    Losing Group Coverage

    • As long as you have continuous coverage, when you lose your group coverage, whether due to retirement or other reasons, you can enroll in Part B with no late enrollment penalty. You have eight months after your group coverage ends to enroll. Enroll even if you're planning to continue coverage through a COBRA plan. COBRA stands for Consolidated Omnibus Budget Reconciliation Act and refers to your right to continue health coverage from up to 18 months after leaving employment, as long as you pay the premiums. COBRA coverage does not count as continuous coverage, so not enrolling in Part B results in a penalty. You also have a special enrollment window once your coverage ends to enroll into a Medicare Part D prescription plan. This lasts 63 days from when your group coverage ends.

    Medigap Open Enrollment

    • According to "Medicare & You," you have a six-month open enrollment period that starts the first month you're both 65 and enrolled in Part B. This initial enrollment period lasts for six months. During this time, enrollment into any Medicare supplement plan is guaranteed, regardless of your health; however, some plans may include a pre-existing condition clause that can last up to six months. If you miss your initial enrollment period you can still apply, but you can be turned down for health reasons.

    Other Options

    • If you miss your initial enrollment period and don't qualify for Medigap, consider a Medicare Advantage plan. Medicare Advantage plans are Health Maintenance Organizations , Preferred Provider Organizations, or Private Fee-for-Service plans, and generally include Medicare Part D prescription coverage. These plans have a monthly premium, along with co-pays and deductibles.

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