Can I Change My Medigap Plan Anytime?

Medicare Supplement plans, often called Medigap, provide coverage for some of the out-of-pocket costs that Original Medicare (Part A and Part B) does not pay. These include expenses such as deductibles, copayments, and coinsurance. Changing from one Medigap plan to another is not always a simple process and typically depends on specific circumstances.

Rules for Changing Your Medigap Plan

Changing your Medigap plan often involves medical underwriting. This process allows insurers to evaluate your health history, current medical conditions, and sometimes require medical tests to approve your application and set premiums. If you have significant health issues, an insurer might charge higher premiums or deny coverage altogether.

However, you can purchase any Medigap policy without medical underwriting during your personal Medigap Open Enrollment Period (OEP). This is a one-time, six-month window that begins the month you turn 65 and are enrolled in Medicare Part B. During this time, insurers cannot deny you coverage or charge more due to health conditions. Outside of this period, medical underwriting applies, unless you qualify for guaranteed issue rights or trial rights.

Guaranteed Issue Rights and Trial Rights

Guaranteed issue rights allow individuals to buy certain Medigap policies without medical underwriting, regardless of their health status. These rights apply in specific situations, ensuring access to coverage when certain other health coverage changes. One common scenario is when you lose employer-sponsored health coverage that supplemented Medicare, including COBRA. In such cases, you typically have a limited window, often 63 days after the coverage ends, to apply for a Medigap plan.

Another situation that triggers guaranteed issue rights occurs if your Medicare Advantage (MA) plan leaves your service area or stops providing coverage. If you move out of your MA plan’s service area, you may also qualify for a guaranteed issue right to switch back to Original Medicare and enroll in a Medigap policy.

Trial rights are a specific type of guaranteed issue right, primarily for those who wish to try a Medicare Advantage plan. If you enroll in a Medicare Advantage plan for the first time when you are initially eligible for Medicare, you have a 12-month trial period. During this period, if you decide the MA plan does not meet your needs, you can disenroll and return to Original Medicare, securing a Medigap policy without medical underwriting.

A second trial right scenario applies if you drop a Medigap policy to enroll in a Medicare Advantage plan for the first time. If you decide within 12 months that the MA plan is not suitable, you can switch back to Original Medicare and potentially get your previous Medigap policy back, or a similar one, without medical underwriting.

The Application and Underwriting Process

If you do not qualify for guaranteed issue rights, the application will undergo medical underwriting. This process involves answering detailed health questions on the application form, covering your medical history, current health conditions, and medications. Insurers might also request medical records or a physical examination to assess your health risk.

Based on this evaluation, the insurer determines whether to issue a policy and at what premium. They can deny coverage entirely or charge a higher premium if your health profile presents a greater risk. It is important to answer all health questions honestly, as insurance companies can compare your application answers with online records, and misrepresentation could lead to policy termination.

For applications submitted under guaranteed issue rights, the process is simpler, as no health questions are asked. General steps involve identifying a suitable insurance company and completing their application form. This form will require personal details, the chosen plan letter, and health information if underwriting is required.

After submitting your application, you should anticipate a response from the insurer. While some decisions, particularly through automated underwriting, can be made within minutes, others might take longer, ranging from 7 to 14 business days, or up to two months. It is advised not to cancel your existing Medigap policy until the new one is approved and becomes effective to avoid any gaps in coverage.

Key Considerations When Changing Plans

Before changing your Medigap plan, evaluate several factors to ensure the new policy aligns with your healthcare needs and financial situation. Medigap plans are standardized with letters (A through N), meaning that the benefits for a specific plan letter are identical across all insurance companies, regardless of who sells it. For instance, a Plan G from one insurer offers the exact same coverage as a Plan G from another.

However, premiums for the same standardized plan letter can vary significantly between insurance companies. These variations often depend on factors such as your age, geographic location, and the insurer’s underwriting methods. It is advisable to compare quotes from multiple insurers for the same plan letter to find the most competitive premium.

Medigap plans are broadly accepted by healthcare providers. If a doctor or hospital accepts Original Medicare, they are required to accept your Medigap plan, regardless of the insurance company that issued it. Medigap policies do not have provider networks, offering flexibility in choosing healthcare professionals.

Beyond benefits and premiums, considering the insurance company’s reputation for customer service and financial stability can also be beneficial. Compare your current plan’s benefits and costs against potential new plans.