Can You Change Medicare Supplement Plans During Open Enrollment?

Medicare Supplement plans, often called Medigap, help individuals manage healthcare costs not fully covered by Original Medicare. While changing Medigap plans is possible, the rules and optimal timing are frequently misunderstood. Understanding the specific conditions and periods for altering your Medigap coverage is important for informed healthcare financial planning.

Understanding Medicare Supplement Plans

Medicare Supplement, or Medigap, plans help cover out-of-pocket costs associated with Original Medicare (Part A and Part B), including deductibles, copayments, and coinsurance. Medigap plans work with Original Medicare, supplementing benefits from Part A (hospital insurance) and Part B (medical insurance).

Private insurance companies offer these plans, generally requiring enrollment in both Medicare Part A and Part B. Plans are standardized across most states by letters like Plan G or Plan N. This means a Plan G from one insurer offers the same basic benefits as a Plan G from another, though premiums can vary. Massachusetts, Minnesota, and Wisconsin have different standardization rules.

Medigap plans differ from Medicare Advantage plans (Part C), which are an alternative way to receive Medicare benefits. Unlike Medicare Advantage plans, Medigap policies do not typically include prescription drug coverage (Part D), so a separate Part D plan is needed for drug coverage. The primary purpose of Medigap is to reduce your financial exposure to healthcare costs under Original Medicare.

Navigating Enrollment Periods for Medigap

The most favorable time to enroll in or change a Medigap policy is during your individual Medigap Open Enrollment Period. This unique, one-time, six-month window begins when you turn 65 and are enrolled in Medicare Part B. During this period, insurers cannot deny coverage or charge higher premiums based on your health status.

Beyond this initial period, individuals may qualify for guaranteed issue rights, allowing them to purchase a Medigap policy without medical underwriting. These rights trigger under specific circumstances, such as losing employer-sponsored health coverage or if a Medicare Advantage plan withdraws from your service area. Moving out of your Medicare Advantage plan’s service area also grants a guaranteed issue right. These rights ensure you can obtain Medigap coverage under qualifying events, generally within 63 days from when prior coverage ended.

If you are outside your personal Medigap Open Enrollment Period and do not have a guaranteed issue right, you can still apply for a new Medigap policy. However, insurance companies are permitted to use medical underwriting. This involves evaluating your health history, and an insurer may deny your application or charge higher premiums based on this assessment.

The Medigap Open Enrollment Period differs from the general “Medicare Open Enrollment Period,” also known as the Annual Enrollment Period (AEP). The AEP runs annually from October 15 to December 7, primarily for changing Medicare Advantage or Part D prescription drug plans. This period does not provide an automatic right to change Medigap plans without medical underwriting, unless a guaranteed issue right coincides.

Steps for Changing Your Medigap Plan

Changing your Medigap plan involves practical steps for a smooth transition and continuous coverage. First, research new plans and carriers in your area that align with your healthcare needs and budget. Compare benefits of standardized plans like Plan G or Plan N, and evaluate how they address out-of-pocket costs. Also compare premiums charged by various providers for the same plan letter.

After identifying potential new plans, contact multiple insurance companies for quotes and detailed policy information. Complete an application for the new Medigap plan. If applying outside your initial Medigap Open Enrollment Period or a guaranteed issue right, be prepared for medical underwriting, which may involve answering health questions and a review of your medical records.

Wait for approval from the new insurance company. The approval process varies, especially with medical underwriting. Receive confirmation of acceptance and the effective date of your new policy before acting on your existing plan. This ensures your new coverage is firmly in place.

Cancel your old Medigap policy only after your new policy is confirmed and active. Cancelling prematurely could lead to a gap in coverage, leaving you responsible for interim healthcare costs. Upon receiving new policy documents, review them to confirm accuracy and understanding of terms and benefits.

Key Factors Before Switching Medigap Plans

Before switching your Medigap plan, evaluate several factors to ensure the change is beneficial. A significant consideration is whether your application will be subject to medical underwriting. If you lack a guaranteed issue right or are outside your initial Medigap Open Enrollment Period, insurers can review your health history, potentially leading to denial or higher premiums.

Premium differences are a primary factor, as costs vary significantly between insurance companies for the same standardized Medigap plan. Obtain quotes from multiple providers to compare premiums, considering age, location, and insurer pricing. Assess if potential premium savings outweigh changes in benefits or underwriting risk.

Assess your current and future coverage needs. While Medigap plans are standardized, ensure the new plan adequately covers anticipated healthcare expenses like deductibles and coinsurance. Medigap plans allow you to see any doctor or visit any hospital that accepts Medicare, so provider networks are not a concern, unlike with some Medicare Advantage plans.

Some individuals transitioning from a Medicare Advantage plan may have federal trial rights, allowing them to return to Original Medicare and purchase a Medigap policy under specific conditions. Always coordinate the effective date of your new Medigap policy with the cancellation of your old one to prevent gaps in coverage or unnecessary overlaps.

Citations

https://www.medicare.gov/medigap-supplement-plans/how-to-buy-and-switch/when-can-i-buy-or-switch-medigap
https://www.medicare.gov/medigap-supplement-plans/medigap-and-medicare-advantage-plans