Can You Change Medigap Plans at Any Time?
Understand the rules and process for changing your Medigap plan. Learn about timing, key considerations, and the steps to update your Medicare supplement coverage.
Medigap plans, also known as Medicare Supplement Insurance, help cover out-of-pocket costs associated with Original Medicare, Parts A and B, such as deductibles, copayments, and coinsurance. These plans are sold by private insurance companies and work in conjunction with your existing Medicare coverage. Understanding the rules for purchasing and changing these policies is important, as the ability to switch plans is not always straightforward and depends on specific timing and eligibility criteria.
Understanding Medigap Enrollment Periods
The most favorable time to enroll in or change a Medigap policy is during your Medigap Open Enrollment Period. This is a one-time, six-month window that begins the first month you are age 65 or older and enrolled in Medicare Part B. During this specific period, insurance companies cannot use medical underwriting to deny you coverage or charge higher premiums based on your health status, ensuring guaranteed acceptance of any Medigap policy they sell. You can enroll in any Medigap policy sold in your state during this time, and policies are generally offered at the lowest available rates. This period is distinct from Medicare’s Annual Election Period and does not repeat annually.
Outside of the Medigap Open Enrollment Period, specific situations may grant you Guaranteed Issue Rights, allowing you to buy a Medigap policy without medical underwriting. These rights ensure that an insurer cannot deny your application or charge you more due to pre-existing health conditions. Common scenarios triggering these rights include losing employer-sponsored group health coverage that supplemented Medicare, or if your Medicare Advantage plan leaves your service area or stops providing coverage.
Another instance where Guaranteed Issue Rights apply is if you switch from a Medigap policy to a Medicare Advantage plan for the first time and then decide to switch back to Original Medicare within 12 months. You generally have a limited timeframe, typically 60 to 63 days, from the date your prior coverage ends to exercise these guaranteed issue rights. It is important to gather proof of the qualifying event, such as a letter from your previous insurer, when applying under these rights.
Key Factors When Considering a Medigap Plan Change
Considering a Medigap plan change outside of your initial Open Enrollment Period or a Guaranteed Issue Right situation involves medical underwriting. This process allows insurance companies to assess your health status before deciding to offer coverage or set your premium. Insurers may ask a series of health questions about your medical history, current conditions, medications, and lifestyle habits like tobacco use. Depending on your health profile, an insurer could deny your application, impose a waiting period for pre-existing conditions, or charge a higher premium.
Comparing Medigap plans involves understanding their standardized benefits, which are identified by letters A through N. While benefits are standardized, the premiums for the same plan letter can vary significantly among different insurance companies. For example, Plan F and Plan G are popular options, with Plan G gaining prominence as Plan F is generally not available to new Medicare enrollees after January 1, 2020.
When evaluating plans, it is important to consider your current and anticipated future healthcare needs and how those align with the coverage provided by different plan letters. Plan availability and pricing structures can also differ by state and by individual insurer. Some plans, like K and L, cover a percentage of costs, while others, like G, cover nearly all out-of-pocket expenses after the Part B deductible.
Steps to Change Your Medigap Plan
Once you have decided to change your Medigap plan, the process begins with selecting a new policy and insurer. This involves identifying the specific Medigap plan letter that aligns with your healthcare needs and budget, and then choosing an insurance company that offers that plan competitively.
The next step is to apply for the new Medigap policy. This typically involves completing an application form, which can often be done online, by mail, or over the phone. If you are applying outside of a guaranteed issue situation, you will need to answer health questions as part of the medical underwriting process. The insurer will review your application and medical information to determine approval and the premium amount.
After submitting your application, you will need to wait for the new policy to be approved and for an effective date to be established. It is important to wait for confirmation that your new Medigap policy is active before taking any action with your old policy. This ensures continuous coverage and helps avoid any gaps in your supplemental insurance protection. Processing times can vary, but some automated underwriting processes may provide a decision within minutes.
Once your new Medigap policy is active, you can then proceed to cancel your old policy. Contact your current Medigap insurer to inform them of your decision to terminate coverage. This sequential approach of securing new coverage before canceling old coverage minimizes the risk of being uninsured for medical expenses not covered by Original Medicare.