Basic Eligibility: The Foundation of Your Coverage
To enroll in any Medicare supplement plan, including one from Aetna, you must be enrolled in both Original Medicare Part A and Part B. Medigap plans are designed to complement Original Medicare coverage.
Age and Residency Requirements
Eligibility generally starts at age 65. The most advantageous time to enroll is during your six-month Medigap Open Enrollment Period (OEP), beginning the month you turn 65 and have Medicare Part B. This period grants 'guaranteed issue' rights, preventing denial or higher premiums due to health. You must also reside where Aetna offers the plan.
The Exception for Individuals Under 65
Federal law doesn't require insurers to sell Medigap to those under 65, but many states do, though specifics vary. Checking with your State Insurance Department is advisable. Individuals under 65 who qualify for Medicare gain standard Medigap OEP rights upon turning 65.
Understanding Key Enrollment Periods
Enrolling at the right time is important, as applying outside your OEP can lead to medical underwriting.
Medigap Open Enrollment Period (OEP)
This six-month period ensures your right to buy any policy sold in your state without health-based denial.
Guaranteed Issue Rights
Certain events, like losing specific coverage, trigger Special Enrollment Periods (SEPs) with guaranteed issue rights, allowing you to buy a Medigap policy without medical underwriting after your OEP.
Medigap vs. Medicare Advantage
You cannot have both Medigap and Medicare Advantage simultaneously. Medigap supports Original Medicare, while Medicare Advantage is an alternative way to receive benefits. Switching from Medicare Advantage to Medigap requires returning to Original Medicare first.
| Feature | Medigap (Supplement) | Medicare Advantage (Part C) |
|---|---|---|
| Works with | Original Medicare (Parts A & B) | All-in-one alternative to Original Medicare |
| Doctor Choice | Any doctor nationwide who accepts Medicare | Often limited to a network of providers |
| Referrals | No referrals needed for specialists | May require a referral for specialists |
| Prescription Drugs | Generally does not include Part D coverage | Usually includes Part D coverage |
| Premiums | Pay a separate premium for the Medigap policy, plus your Part B premium. | Can have low or $0 monthly premiums, but higher potential out-of-pocket costs. |
| Out-of-Pocket Maximum | No annual maximum (Plans K and L are exceptions) | Has a yearly limit on out-of-pocket spending. |
Aetna-Specific Enrollment Details
Aetna's plans follow federal standardization but vary by state. Popular options like Plans G and N are often available. Aetna may offer a household discount in some states if you live with another Medicare-eligible adult who also applies. Confirm plan availability with Aetna or an agent. For information on rights and options, visit {Link: Medicare https://www.medicare.gov}.
Conclusion: Navigating Your Aetna Medigap Eligibility
Eligibility requires enrollment in Original Medicare Parts A and B, meeting age, residency, and enrollment timing factors. The best opportunity is your six-month Medigap Open Enrollment Period. State laws govern eligibility for those under 65.
