The Elder Law Forum

The Elder Law Forum by Professor Michael Myers Crawling Through Medigap's Six-Month Window

The failure to crawl through Medicare's six-month open enrollment window for Medicare supplemental insurance can be costly.

"Open enrollment" requires health insurance carriers selling "Medigap" insurance to issue a policy at state-approved rates to any Medicare beneficiary, healthy or sick, who applies for coverage within six months after becoming eligible for Medicare. Usually that is at age 65, or earlier, if a person becomes eligible because of Social Security disability.

Once the six-month period has lapsed, an insurance company may screen applicants for pre-existing conditions and may legally refuse to insure a person it believes to be an unacceptable risk. In fact, it may be that no carrier will issue a policy to such a person.

"I've contacted five insurance companies and none of them will accept me," said a USD Senior Legal Helpline (1-800-747-1895; myers@usd.edu) caller, a 57-year-old woman who has been receiving Social Security disability benefits for 10 years, and became eligible for Medicare in 1999 under a law that makes Medicare supplemental insurance available to persons who qualify for Medicare, whether on the basis of age or disability.

She said she could not afford a Medigap policy when she became Medicare-eligible and was unable to take advantage of the six-month open-enrollment window. Recently, however, she became the beneficiary of a family trust and realizes that medical expenses not covered by Medicare, plus co-pays and deductibles, could deplete her share of the trust.

"The lawyer for the trust asked me to ask you whether I could require a company to issue me a supplemental policy, or whether the state catastrophic health insurance pool would have to accept me," the caller said. Regrettably, I informed her, the answer to both questions is no.

Under existing law, the six-month open enrollment period for guaranteed issuance is final. If the deadline is missed, a Medicare beneficiary with a chronic illness may spend the rest of her or his life without the supplemental protection that has become increasingly important as healthcare costs have soared.

State insurance pools are intended to offer coverage (at high rates) to persons unable to obtain insurance in the private market. However, persons covered by Medicare are deemed to be "insured," and therefore not eligible for coverage under a pool designed for the uninsurable.

Also, a person must enroll under Medicare Part B to be eligible for supplemental insurance. So, remember, when you become Medicare eligible, sign up for Part B and select a Medigap policy within six months. The failure to do so can be costly.

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