Can I Change My Medicare Supplement Plan?

Medicare Supplement (Medigap) plans help cover costs that Original Medicare (Part A and Part B) does not, such as deductibles, copayments, and coinsurance. These plans are offered by private insurance companies and work with Original Medicare, not instead of it. Changing a Medigap plan is possible, and understanding the process is important for ensuring continuous healthcare coverage.

When You Can Change Your Plan

Changing a Medicare Supplement plan is possible, with ease depending on when the change is sought. The most favorable time to enroll in a Medigap policy, or switch plans without extensive health questions, is during specific enrollment periods or when guaranteed issue rights apply.

One such period is the Initial Medicare Supplement Open Enrollment Period, a one-time, six-month window that begins the first month an individual is both 65 or older and enrolled in Medicare Part B. During this period, insurers cannot deny coverage or charge higher premiums based on health conditions, allowing individuals to purchase any Medigap policy sold in their state without medical underwriting.

Outside of this initial enrollment period, individuals typically must undergo medical underwriting to switch Medigap plans. Medical underwriting involves an assessment of an applicant’s health status, medical history, and other risk factors. This process often includes answering detailed health questions, and may involve a review of medical records or a health exam. Based on this assessment, an insurer can accept an application, accept it with higher premiums, or deny coverage entirely, especially if pre-existing health conditions exist.

Certain situations grant individuals “guaranteed issue rights,” allowing them to buy a Medigap policy without medical underwriting, even outside their initial open enrollment period. These rights mean insurers cannot deny coverage or charge more due to health status. Common scenarios include losing employer-sponsored health coverage that supplemented Medicare, a Medicare Advantage plan leaving the service area or being discontinued, or moving out of a plan’s service area. Another instance is if an individual drops a Medigap policy to enroll in a Medicare Advantage plan for the first time, and then decides within 12 months to switch back to Original Medicare and a Medigap plan. These guaranteed issue periods typically have specific timeframes, often around 63 days, during which the right must be exercised.

Beyond federal provisions, some states offer additional “guaranteed issue” periods or rules, such as a “birthday rule” or “anniversary rule.” These state-specific rules typically allow individuals to change Medigap plans, often to a plan with equal or lesser benefits, without medical underwriting annually around their birthday or policy anniversary. Individuals should consult their state’s insurance department to understand any specific regulations that may apply.

Factors to Consider When Changing Plans

Evaluating a new Medicare Supplement plan requires careful consideration to ensure it aligns with current and future healthcare needs. Medicare Supplement plans are standardized, meaning plans of the same letter (e.g., Plan G) offer the same basic benefits regardless of the insurance company selling them. This simplifies comparing coverage between different insurers for the same plan letter. However, it is important to compare the benefits of different plan letters (e.g., Plan G versus Plan N) to determine which plan type best meets specific healthcare requirements, as coverage levels vary significantly. For instance, Plan G generally offers comprehensive coverage, while Plan N may have lower premiums but includes copayments for certain office visits and emergency room use.

Premium costs are a significant consideration, as these can vary widely among insurance companies for the exact same standardized plan letter. Factors influencing premiums include the insurer, geographic location, age, and the results of medical underwriting. Some policies are “attained-age-rated,” meaning premiums increase as an individual gets older, while “issue-age-rated” plans base premiums on the age at enrollment and generally keep that rate, subject to inflation and other factors. Comparing premium quotes for the identical plan type from multiple companies is a prudent step.

The reputation and financial stability of the insurance company offering the new plan are also important to research. Individuals should confirm that their preferred doctors and hospitals accept Medicare, as Medigap plans work with Original Medicare. Medigap policies typically do not have network restrictions, offering flexibility in choosing healthcare providers.

Finally, Medicare Supplement plans do not cover prescription drugs. Individuals will need to enroll in a separate Medicare Part D prescription drug plan to obtain this coverage. Neglecting to enroll in a Part D plan when first eligible can result in a late enrollment penalty that applies for the lifetime of the Part D coverage.

How to Change Your Medicare Supplement Plan

Changing a Medicare Supplement plan involves actions to ensure a smooth transition without gaps in coverage. The initial step involves thorough research and comparison of available plans and insurers to select a new policy that aligns with current healthcare needs and budget. This research can include reviewing plan benefits, comparing premium costs, and assessing the financial strength and reputation of potential insurers.

Once a new plan and insurer are chosen, apply for the new Medigap policy. It is essential to receive approval for the new plan before canceling the existing one. This prevents any period without supplemental coverage, which could leave an individual responsible for significant out-of-pocket medical expenses. Applications can typically be submitted online, by phone, or through a licensed insurance agent.

If the application occurs outside of a guaranteed issue period, the new insurer will likely conduct medical underwriting. This process evaluates health history to determine eligibility and premium rates. Upon approval, the new insurer will provide confirmation and policy documents detailing the new coverage and its effective date.

After receiving confirmation and new policy documents, and ensuring the new plan is active, formally cancel the old Medigap policy. Many new policies offer a 30-day “free-look period,” allowing an individual to hold both policies simultaneously while making a final decision. During this time, premiums for both policies must be paid. Do not cancel the old policy until the new one is fully active and satisfactory to avoid any lapse in coverage. Coordinating the effective date of the new policy with the cancellation of the old one helps maintain continuous supplemental coverage.