Can I Switch Medicare Supplement Plans?

Medicare Supplement (Medigap) plans help cover out-of-pocket costs not paid by Original Medicare, such as deductibles, copayments, and coinsurance. Switching these plans is generally possible, but depends on specific circumstances and timing. This article explains when you can change your Medigap plan, the steps involved, and important considerations before switching.

Understanding When You Can Switch

Switching Medicare Supplement plans involves specific rules. Most Medigap plans require medical underwriting, meaning an insurance company can evaluate your health status to decide whether to accept your application or adjust your premium.

A significant opportunity to obtain a Medigap policy without medical underwriting is during your Medigap Open Enrollment Period. This is a one-time, six-month period that begins the month you turn 65 and are enrolled in Medicare Part B. During this timeframe, insurance companies cannot deny you coverage or charge you higher premiums due to pre-existing health conditions. You are guaranteed access to any Medigap policy sold in your state, often at the best available rates.

Beyond this initial window, specific situations known as “Guaranteed Issue Rights” allow you to purchase a Medigap policy without medical underwriting. Common scenarios that trigger these rights include:

• Losing employer-sponsored group health coverage.
• Your Medigap company goes out of business.
• Moving out of your Medicare Advantage plan’s service area.
• Your Medicare Advantage plan leaves the Medicare program.
• Switching from a Medigap policy to a Medicare Advantage plan for the first time and deciding to return to Original Medicare within 12 months (trial right).

If you do not have a Guaranteed Issue Right or are outside your Medigap Open Enrollment Period, medical underwriting will likely apply. In such cases, insurance companies can refuse to sell you a policy or impose a waiting period for pre-existing conditions. This means that simply wanting a lower premium without a qualifying event might lead to a denial or a higher premium based on your health history.

Steps to Change Your Plan

The initial step involves thorough research and comparison of available plans. This phase focuses on identifying which insurance companies offer the Medigap plans you are considering in your area.

Next, contact the insurance companies offering the desired Medigap plans. This can often be done through their websites, by phone, or by working with a licensed insurance agent. The application process will require you to provide personal information, including your Medicare details.

Completing the application may involve answering health questions if you are applying outside of a guaranteed issue period. Provide accurate and complete information on the application. Upon submission, the insurance company will review your application and, if applicable, conduct medical underwriting.

If your application is approved, you will receive confirmation and your new policy documents. Review these documents carefully to ensure they match your expectations, including verifying the effective date of your new coverage.

Avoid gaps in coverage by not canceling your old Medigap policy until your new policy is approved and effective. You may have a “free-look period,” typically 30 days, during which you can have both policies active and decide if the new one meets your needs. During this overlap, you will be responsible for paying premiums for both policies. Once the new policy is confirmed and active, contact your previous insurance provider to cancel your old policy, ensuring a seamless transition of coverage.

Key Considerations Before Switching

Medigap plans are standardized by letters (A, B, C, D, F, G, K, L, M, N), meaning a Plan G from one insurer offers the exact same basic benefits as a Plan G from another. The only difference between standardized plans of the same letter from different companies is the cost.

Understanding the specific benefits of each standardized plan is important. For instance, Medigap Plan G is comprehensive, covering most out-of-pocket costs not paid by Original Medicare, including Part B excess charges. Plan N, while generally having lower premiums than Plan G, does not cover Part B excess charges and may require small copayments for doctor visits and emergency room use. These differences in covered services directly impact your potential out-of-pocket expenses.

Premiums are a primary concern. Medigap premiums can vary significantly between insurance companies for the same standardized plan due to various rating methods, such as attained-age, issue-age, or community-rated pricing. Factors like your age, geographic location, and smoking status can influence the premium you pay.

Your current health status is important, especially if medical underwriting is required for the switch. If you are not in a guaranteed issue period, your health history can impact both your eligibility for a new plan and the premium charged. Assess whether potential savings on premiums outweigh the risk of being denied coverage or facing higher costs due to health conditions.

While Medigap plans generally allow you to see any doctor or hospital that accepts Medicare, confirm network acceptance. Research the financial stability and customer service reputation of any potential new insurance company. This research provides confidence in the company’s ability to handle claims and provide support.

Some states have specific rules, such as a “birthday rule” or continuous open enrollment periods, which may offer additional opportunities to switch plans without medical underwriting. While these rules vary by location, they can provide flexibility beyond federal guidelines. Staying informed about these state-specific regulations can uncover favorable switching options.