Can I Change Medicare Supplement Plans Without Underwriting?

Medicare Supplement (Medigap) plans help cover out-of-pocket costs that Original Medicare does not, such as deductibles, copayments, and coinsurance. When seeking to enroll in or change these plans, individuals typically encounter a process known as medical underwriting. This involves answering health questions and can result in higher premiums or even denial of coverage based on pre-existing conditions. However, specific situations and regulations allow individuals to bypass this underwriting requirement, providing opportunities to switch plans without health-related obstacles.

Understanding Underwriting for Medicare Supplement Plans

Underwriting in the context of Medicare Supplement plans refers to the process insurance companies use to assess an applicant’s health status and determine their risk level. Insurers typically ask detailed health questions on the application to evaluate pre-existing conditions and medical history. This assessment allows the company to decide whether to offer coverage, at what premium rate, or if they will deny coverage entirely.

The primary purpose of underwriting is to manage the insurer’s financial risk by ensuring that the premiums collected adequately cover the expected claims from policyholders. Without specific exceptions, applicants generally face these health questions, and their answers directly influence the availability and cost of their desired plan. A history of certain health conditions can lead to higher monthly premiums or even the inability to purchase a Medigap policy.

Guaranteed Issue Rights

Federal law provides specific “Guaranteed Issue” rights, often called Medigap protections, which allow individuals to enroll in a Medicare Supplement plan without medical underwriting. During these periods, insurers cannot deny coverage, place conditions on a policy, or charge higher premiums due to health status. These rights are triggered by certain qualifying events and require action within specific timeframes.

Common qualifying events include:
Loss of group health coverage that supplemented Medicare, such as employer-sponsored, COBRA, or retiree coverage. If this coverage ends, individuals typically have 63 days from the date their previous coverage stopped to apply for a Medigap policy.
An Original Medicare Advantage (MA) plan leaving a service area or stopping coverage, or if you move out of an MA plan’s service area. This grants a 63-day window to switch to a Medigap plan.
An MA plan violating its contract or misleading an enrollee.
A “trial right” for individuals who initially joined an MA plan when they first became eligible for Medicare at age 65. They can switch back to Original Medicare and enroll in a Medigap plan without underwriting if they do so within the first 12 months.
A second “trial right” applies to those who dropped a Medigap policy to join an MA plan for the first time. If they decide to switch back to Original Medicare within the first year of joining the MA plan, they can re-enroll in their previous Medigap policy or a different one without underwriting.

State-Specific Protections and Rules

Beyond federal Guaranteed Issue rights, some states offer additional protections that allow individuals to change Medicare Supplement plans without underwriting. These state-specific rules provide more flexibility for policyholders. However, these rules vary significantly by state, and not all states have the same provisions.

A widely recognized state protection is the “Birthday Rule,” adopted by states like California, Oregon, and Nevada. This rule generally allows Medigap policyholders to switch to a different Medigap plan with the same or lesser benefits from any insurer without underwriting around their birthday. The specific timeframe for this rule typically ranges from 30 to 60 days starting from the policyholder’s birthday. Some states also implement annual open enrollment periods that extend beyond the initial Medicare enrollment period. For instance, states like Missouri have an “Anniversary Rule” that permits individuals to change Medigap plans without underwriting around the anniversary of their policy’s effective date. Washington state has year-round open enrollment, meaning individuals can switch Medigap plans at any time without medical underwriting.

Steps to Change Your Medicare Supplement Plan

Changing a Medicare Supplement plan involves several practical steps, whether you qualify for a guaranteed issue right, a state-specific protection, or are prepared for underwriting.
The initial step involves comparing different Medigap plans, such as Plans G or N, and various carriers based on their benefits and premium costs. It is important to assess which plan best aligns with your healthcare needs and financial situation.
Next, you should contact several insurance companies to obtain quotes for the plans you are considering. This allows you to compare pricing and customer service among different providers. Many insurers offer online quote tools or have agents available to assist with this process.
When you are ready to apply, the application process will vary depending on whether you are exercising a guaranteed issue right or state protection. If you qualify for one of these exceptions, the application will not include health questions. If no exception applies, you will need to answer health questions as part of the underwriting process.
It is important to manage effective dates carefully to ensure continuous coverage and avoid any gaps between policies. Coordinate with your new insurer to establish a clear effective date for your new policy.
Finally, do not cancel your old Medicare Supplement policy until your new policy has been officially issued and is active. This ensures uninterrupted coverage and prevents any lapse in benefits.