Can You Change Medigap Plans Each Year?

Medigap, a private insurance policy, helps manage healthcare costs not fully covered by Original Medicare, such as copayments, coinsurance, and deductibles. These policies provide more predictable out-of-pocket costs for beneficiaries.

There are various standardized Medigap plans, identified by letters, each offering different combinations of benefits to supplement Original Medicare. Beneficiaries pay a monthly premium to a private insurer for their Medigap policy, in addition to their Medicare Part B premium. Medigap policies are distinct from Medicare Advantage plans, which offer an alternative way to receive Medicare benefits.

Medigap Enrollment and Switching Rules

The ideal time to enroll in a Medigap policy is during your individual Medigap Open Enrollment Period. This six-month window begins on the first day of the month you are both 65 or older and enrolled in Medicare Part B. During this period, insurance companies cannot use medical underwriting, meaning they cannot deny coverage or charge higher premiums based on your health status or pre-existing conditions.

Once this initial Medigap Open Enrollment Period concludes, it does not repeat annually. If you apply for a Medigap policy outside of this window, insurers generally have the right to use medical underwriting. This process involves reviewing your medical history, asking health questions, and potentially requiring medical exams to assess risk.

Based on this assessment, an insurance company can deny coverage, charge higher premiums, or impose waiting periods for pre-existing conditions. Unlike Medicare Advantage or Part D plans, there is no federal annual open enrollment period for Medigap policies where medical underwriting is waived.

Guaranteed Issue Rights for Medigap

Under specific circumstances, individuals may qualify for “guaranteed issue rights,” allowing them to purchase a Medigap policy without medical underwriting. This means insurers cannot deny coverage, impose waiting periods for pre-existing conditions, or charge more due to health issues. These rights protect beneficiaries who lose certain types of health coverage.

One common scenario involves the loss of employer-sponsored group health coverage that supplemented Medicare. If such coverage ends, you typically have a limited timeframe, often 63 days from the date your previous coverage terminates, to apply for a Medigap policy under guaranteed issue. This right ensures a seamless transition for those whose workplace benefits conclude.

Another situation applies if your Medigap insurance company goes bankrupt or leaves the market, or if you move out of your policy’s service area. In these instances, you gain guaranteed issue rights to enroll in a new Medigap policy.

Individuals who initially join a Medicare Advantage Plan when first eligible for Medicare Part A at age 65, and decide to switch back to Original Medicare within the first 12 months, also have a “trial right.” A similar trial right exists if you drop a Medigap policy to join a Medicare Advantage Plan for the first time and then decide to switch back to Original Medicare within a year. These trial periods typically require you to apply for a Medigap policy within a window starting 60 days before and ending 63 days after your Medicare Advantage coverage ends.

Steps for Switching Medigap Plans

When considering a change to your Medigap coverage, the initial step involves thoroughly researching available plans in your area. This includes comparing different standardized plans, such as Plan G or Plan N, and reviewing their associated costs and benefits from various insurers. Understanding the financial strength and customer reviews of potential new carriers can also be a valuable part of this process.

Once you have identified potential new policies, contact the insurance companies to obtain specific quotes and application forms. If you are outside your initial Medigap Open Enrollment Period and do not have guaranteed issue rights, be prepared to answer detailed health questions for medical underwriting.

For those who qualify for guaranteed issue rights, clearly indicate this on your application and provide any necessary documentation proving your eligibility. This might include letters or notices from your previous insurer regarding the termination of coverage.

Upon receiving approval for a new Medigap policy, it is important to avoid canceling your existing plan prematurely. Maintain your current coverage until the new policy’s effective date is confirmed and you have received all necessary documentation. After confirmation, contact your former insurer to formally cancel your old policy, often requiring a written request or specific form. This careful timing ensures continuous coverage and prevents any gaps in your supplemental benefits.