Can I Switch Medigap Plans? What to Know

Medicare Supplement Insurance, known as Medigap, is sold by private insurance companies. These policies help cover healthcare costs that Original Medicare (Parts A and B) does not fully pay. When you have both Original Medicare and a Medigap policy, Medicare pays its approved share first, and then the Medigap policy contributes to the remaining costs. This reduces potential out-of-pocket expenses for services covered by Original Medicare.

Understanding Medigap Plans

Medigap plans work with Original Medicare to manage out-of-pocket expenses like deductibles, copayments, and coinsurance. For instance, while Original Medicare typically covers about 80% of approved medical expenses, a Medigap policy can help pay the remaining 20%. This supplemental coverage can lessen the financial burden for medical services.

Medigap plans are standardized across most states. Each lettered plan (A through N) offers the same basic benefits regardless of the insurance company. For example, a Plan G from one insurer provides the same coverage as a Plan G from another; the primary difference is usually the cost. Medigap policies do not include prescription drug, vision, or dental coverage.

When You Can Switch Medigap Plans

Switching Medigap plans depends on specific periods and conditions. The best time to switch is during your Medigap Open Enrollment Period. This is a one-time, six-month period that begins the first month you are 65 or older and enrolled in Medicare Part B.

During this six-month window, insurance companies cannot refuse to sell you any Medigap policy offered in your state, regardless of your health status. They also cannot charge higher premiums based on pre-existing health conditions or use medical underwriting to deny coverage. This period offers the widest range of choices.

Outside this initial enrollment period, you may have “guaranteed issue rights” in certain situations. These rights ensure that an insurance company must sell you a Medigap policy, cannot use medical underwriting, and must cover pre-existing conditions. Examples of situations that trigger guaranteed issue rights include losing employer group health coverage that supplemented Medicare, your Medigap company going bankrupt, or moving out of your plan’s service area. Another guaranteed issue right applies if you leave a Medicare Advantage plan under specific circumstances, such as moving out of the plan’s service area, or if you were in a Medicare Advantage plan for the first time and switch back to Original Medicare within the first 12 months. In these cases, you generally have a 63-day window to apply for a Medigap policy.

If you switch Medigap plans outside your Medigap Open Enrollment Period or a guaranteed issue situation, you will be subject to medical underwriting. This is a process where the insurer evaluates your health history, current health conditions, and lifestyle choices to determine the risk of insuring you. The insurer can ask health questions, potentially deny coverage, or charge higher premiums based on your health status.

Factors to Consider Before Switching

Before switching your Medigap plan, consider several factors to ensure the new policy aligns with your healthcare and financial needs. Your current health status is a consideration, especially if you are not in a guaranteed issue period. If you have developed new health conditions, you may face medical underwriting, which could result in higher premiums or denial of coverage for a new policy.

Compare premium differences, as costs can vary significantly between companies for the same standardized plan. Medigap policies can use different pricing methods: “attained-age” means premiums increase as you get older; “issue-age” means premiums are based on your age when you first bought the policy and generally do not increase due to age; and “community-rated” means everyone in a specific area pays the same rate regardless of age. Understanding these structures helps predict future premium changes.

Assess whether your current coverage still meets your needs or if a different plan would be more suitable. For example, if your healthcare usage has changed, moving from a comprehensive plan to a less extensive one, or vice versa, might be financially advantageous.

Steps to Switch Your Medigap Plan

Begin by researching and comparing available Medigap plans and insurance companies in your area. While plan benefits are standardized, premiums and customer service can vary, making comparison essential.

Apply for the new Medigap policy. This application can often be completed online, over the phone, or through a licensed insurance agent. If medical underwriting is required, be prepared to answer health-related questions truthfully, as the insurer will use this information to assess your eligibility and set your premium.

After submitting your application, wait for confirmation of acceptance from the new Medigap insurer. Do not cancel your existing policy until you have received this approval and the new policy is active. You typically have a “free look” period, often 30 days, during which you can review the new policy and decide if you want to keep it. During this period, you may need to pay premiums for both policies.

Once your new policy is confirmed and active, cancel your old Medigap policy. Contact your previous insurance company directly, typically by phone or in writing, to formally request cancellation. Verify the effective dates of both your new and old policies to ensure there is no gap in your coverage, maintaining continuous protection.