Why Applying for a Medicare Supplement at the Right Time is Essential

Dear Toni,

Last June, my employer offered me a great retirement package, with 18 months of COBRA at no cost for me and my husband John. My coverage ends on December 31^st. I am 62 and will not be enrolling in Medicare for a while. Meanwhile, my husband is 72. In June 2022, he enrolled in Medicare Part B when COBRA began, because he was having heart surgery. He enrolled in Medicare Part A in 2018.

John needs help with applying for a Medicare Supplement. However, he’s been denied for health issues because he must answer underwriting questions. Why is it so complicated to apply for a Medicare Supplement? What did we do wrong when I retired? 

Please explain what John’s Medicare options are.

Thanks,
Sarah from Pearland, Texas

Hello Sarah,

I have good news for you and John. There happens to be a Medicare Supplement rule that can keep him from answering underwriting questions, despite his heart issues.

Since John will be losing his COBRA company benefits, he qualifies for the 63-day guaranteed issue period. This means he can purchase a Medicare Supplement/Medigap plan, without medical underwriting. He will need your company benefits termination letter to prove that he is, in fact, in the guaranteed issue period.

Isn’t it amazing how complicated Medicare rules can be?

The Medicare & You handbook explains this in further detail. Original Medicare and an employer group health plan (including retiree or COBRA coverage) will pay after Medicare, once the plan ends. In other words, John is eligible for a Medicare Supplement without medical underwriting.

With guaranteed issue, an insurance company must do the following:

1. Sell you a Medigap/Medicare Supplement policy.

You have the right to buy Medigap/Medicare Supplement Plans sold in your state through any insurance company. John isn’t eligible for Plan G. However, since his Medicare Part A began in 2018, he is eligible for Medicare Plan F or C. Plans F and C are only available to those eligible for Part A prior to January 1, 2020.) Those whose Medicare Part A began after January 1, 2020, are eligible for Plan G but not Plans F or C.

2. Cover all pre-existing health conditions.

No insurance company can reject you, charge more, or refuse to pay for essential health benefits for any condition you had prior to coverage.

3. Cannot charge you more for a Medigap policy, regardless of past or present health problems.

When you and John attended your personalized Medicare consultation, I could see the relief on both of your faces when I designed a plan that met your financial needs. John’s prescriptions for his heart issues were expensive. Fortunately, he could wait to enroll in a Medicare Part D plan, set to begin January 1, 2024. John has time to discover if there are any generics that can be substituted for the brand-name medications. After all, he now has an affordable co-pay!

Sarah, you have 3 years to wait to enroll in Medicare. For now, you’ll need an under-65 health insurance plan for all your coverage needs.

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