Medicare Supplement Plans
What is a Medicare Supplement (or Medigap) Plan?
Medicare supplement plans are one health insurance option for people with Original Medicare. There are standardized Medicare supplement insurance plans available that are designed to fill the gaps left by Original Medicare (Parts A and B). These are sold by private insurance companies as individual insurance policies and are regulated by the Department of Insurance. After age 65 and for the first six months of eligibility for Medicare Part B, beneficiaries have an Open Enrollment Period and are guaranteed the ability to buy any of these plans from any company that sells them. Companies cannot deny coverage or charge more for current or past health problems. If you fail to apply for a Medicare supplement within your Open Enrollment Period, you may lose the right to purchase a Medicare supplement policy without regard to your health.
Are you considering a Medicare Supplement Plan?
SHIIP's interactive tool allows individuals to compare Medicare supplement plans at the touch of their fingers. By simply entering your age, gender, the Medicare supplement plan you want to compare, and whether or not you use tobacco products, the computer will generate a list of the companies offering that plan along with their estimated premiums. By clicking on the company name, you will be directed to other important aspects of the product. This site has the most up-to-date information of plans available in North Carolina.
You will not be auto enrolled into a Medicare Supplement Policy and must make application directly with the insurance company. You will need to contact the insurance company that sells the specific policy you wish to purchase or you may contact an agent who sells the specific policy you wish to purchase. We recommend that you apply at least 30 days before you want the policy to start. If you do not have 30 days, apply as soon as possible. Supplement premiums are paid directly to the insurance company and are not deducted from your Social Security payments.
What's New for Medicare beneficiaries under age 65?
Medicare Supplemental Insurance federal regulations do not guarantee eligibility to individuals under age 65 who are eligible for Medicare due to disability. However, thirty-three states have adopted state legislation extending guarantee issue to that group of individuals. North Carolina is one of the states that legislatively mandates eligibility to individuals eligible for Medicare due to disability.
North Carolina G.S. 58-54-45 guarantees that individuals under the age of 65 who qualify for Medicare are eligible to purchase a Medigap policy A, D, and G effective January 1, 2020. This change took place due to changes in federal legislation regarding Medigap Plans A, C, and F.
Below is the link to review the new regulation.
What is the Open Enrollment Period?
The open enrollment period is six months from the date a beneficiary is enrolled in Medicare Part B. During the open enrollment period, a person under 65 and on Medicare disability is only able to purchase Medicare supplement insurance Plans A, D or G. This is a special North Carolina law.
During the open enrollment period, the applicant is guaranteed to be issued a policy. Premiums may be higher for Medicare disability beneficiaries than for Medicare beneficiaries 65 or older. The insurance company may impose a pre-existing condition waiting period, but it cannot be longer than six months. This would include any health condition diagnosed or treated six months prior to the Medicare supplement application. If a person has prior creditable coverage, the waiting period must be waived. Creditable coverage is when the beneficiary has been covered by insurance or Medicaid for six months prior to the effective date of the Medicare supplement insurance policy. When a Medicare disabled beneficiary turns 65 years old, he or she will have a new six-month open enrollment period and be able to purchase any of the standardized Medicare supplement insurance.
For those persons that are retroactively enrolled in Medicare Part B due to a retroactive eligibility decision made by the Social Security Administration, the application must be submitted within a six-month period beginning with the month in which the person receives notification of the retroactive eligibility decision.