Can You Change Medicare Supplement Plans Without Underwriting?

Medicare Supplement, often called Medigap, provides coverage for costs that Original Medicare (Parts A and B) does not fully cover. Private insurance companies sell these plans to help manage out-of-pocket expenses such as deductibles, copayments, and coinsurance. A Medigap policy works with Original Medicare, offering more predictable costs and fewer unexpected out-of-pocket expenses for beneficiaries.

Understanding Medicare Supplement Underwriting

Medical underwriting is a process insurance companies use to assess an individual’s health status and medical history before issuing a Medicare Supplement policy. This evaluation helps insurers determine the likelihood of future claims and decide whether to accept an applicant, set premiums, or impose waiting periods. When applying for a Medigap plan outside specific protected periods, individuals typically undergo this process. An insurer might deny coverage, charge higher premiums, or apply waiting periods for pre-existing conditions if health issues are present.

Federal Guaranteed Issue Rights for Plan Changes

Federal “guaranteed issue” rights allow individuals to change Medicare Supplement plans without medical underwriting. These rights mean insurance companies cannot deny coverage or charge more due to health conditions. Most guaranteed issue situations require applying for a new Medigap policy within 63 days of losing prior coverage. You are generally guaranteed the right to purchase Medigap Plans A, B, D, G, K, or L. If eligible for Medicare before January 1, 2020, you may also purchase Plans C or F.

One common situation involves losing employer group health coverage that supplemented Medicare, including COBRA. If this coverage ends involuntarily, you qualify for a guaranteed issue right.

Another scenario occurs if your Medicare Advantage (MA) plan leaves its service area or does not renew its contract with Medicare. If you move out of your MA plan’s service area, you also gain a guaranteed issue right to switch back to Original Medicare and enroll in a Medigap plan. In some cases where an MA plan terminates coverage, you may have up to 123 days to apply for a Medigap policy.

Two “trial rights” also provide guaranteed issue protections. The first applies if you joined an MA plan or Program of All-Inclusive Care for the Elderly (PACE) when first eligible for Medicare Part A at age 65, and you switch back to Original Medicare within 12 months. The second is for individuals who dropped a Medigap policy to join an MA plan for the first time and then decide to leave the MA plan within 12 months.

Additional federal guaranteed issue rights apply if your Medigap or Medicare SELECT policy ends due to insurer bankruptcy or fraud. You also qualify if you leave a Medigap or Medicare Advantage plan because the company misled you or failed to follow Medicare rules.

State-Specific Enrollment Protections

Beyond federal guaranteed issue rights, several states offer additional protections allowing individuals to change Medicare Supplement plans without underwriting. A notable example is the “Birthday Rule,” available in states such as California, Oregon, Nevada, Illinois, Idaho, Kentucky, Louisiana, Maryland, Oklahoma, Utah, and Virginia. This rule generally permits individuals with an existing Medigap plan to switch to another plan with equal or lesser benefits around their birthday without health questions. The specific timeframe for this enrollment period varies by state, typically 30 to 60 days.

Some states also have continuous open enrollment periods or other unique provisions for Medigap policies. For instance, in states like New York, Connecticut, and Massachusetts, individuals may have ongoing opportunities to enroll in Medigap plans without medical underwriting. These state-specific rules are not available nationwide and vary considerably from one state to another.

How to Change Your Medicare Supplement Plan

If you qualify for a guaranteed issue right or a state-specific protection, changing your Medicare Supplement plan involves a clear process. The initial step is to research and compare Medigap plans and insurers in your area to determine which option best suits your needs. Once you select a new plan, contact the chosen insurance company and inform them you are exercising a guaranteed issue right or a state-specific enrollment protection. This signals that health questions on the application should be waived.

You will need to complete the application form provided by the new insurer. While health questions are generally waived, you may need to provide documentation to prove your eligibility, such as a letter from your previous insurer confirming loss of coverage. After submitting your application and any required proof, the new policy’s effective date will be established. Never cancel your existing Medigap policy until the new one is confirmed and fully effective. Many states offer a “free-look” period, often 30 days, allowing you to have both policies active to ensure the new coverage meets your expectations before canceling the old one.