Can You Switch Medicare Supplement Plans Anytime?

Medicare Supplement plans, often called Medigap, are designed to work alongside Original Medicare (Part A and Part B) to help cover out-of-pocket costs such as deductibles, copayments, and coinsurance. While switching is generally possible, it is subject to specific conditions and processes that can impact eligibility and cost. This article will clarify the conditions and process for switching Medigap plans.

Understanding Medigap Switching Rules

While you generally can apply to switch Medigap plans at any time, acceptance is not always guaranteed. Federal regulations and specific state laws govern the ability to change Medigap policies. These rules exist to balance consumer protections with the financial considerations of insurance providers.

The ability to switch typically falls under two primary pathways: medical underwriting or guaranteed issue rights. Medical underwriting involves an assessment of your health by the insurance company, which can influence whether you are accepted, what premium you pay, or if a waiting period applies. Conversely, guaranteed issue rights are specific situations where an insurer must sell you a Medigap policy without considering your health status.

Guaranteed Issue Rights Explained

Guaranteed issue rights allow Medicare beneficiaries to enroll in a Medigap policy without medical underwriting, meaning insurers cannot deny coverage or charge higher premiums due to health conditions. These rights are triggered by specific events and typically come with a limited timeframe for action, often 63 days from the qualifying event. During these periods, insurers are compelled to accept your application for certain standardized Medigap plans.

Several common scenarios grant these important rights. For instance, if you lose employer group health coverage that paid after Medicare, or your Medigap plan goes out of business, you generally gain guaranteed issue rights. Moving out of your current Medicare Advantage plan’s service area or if your Medicare Advantage plan stops operating in your area also triggers these protections. Additionally, if you tried a Medicare Advantage plan for the first time and decide to switch back to Original Medicare within the first 12 months, you have a trial right to return to Medigap without underwriting.

Other situations include your current Medigap plan violating its contract or misleading you, which also grants a guaranteed issue right. It is important to gather proof of the qualifying event, such as a termination letter from a previous insurer, as this will be required when applying for the new Medigap policy.

The Role of Medical Underwriting

Medical underwriting is the process insurance companies use to evaluate an applicant’s health status when they apply for a Medigap plan outside of specific protected periods, such as their initial enrollment period or a guaranteed issue event. This assessment helps the insurer determine risk and influences their decision to offer coverage, the premium charged, and any potential waiting periods. Insurers will typically ask a series of health questions about your medical history, current conditions, and even lifestyle factors like tobacco use.

The insurance company may review your medical records, prescription drug history, and other health data. The potential outcomes of medical underwriting include being approved for coverage, approved at a higher premium due to health risks, or being denied coverage altogether. Severe or chronic illnesses often lead to denial, though guidelines vary by insurer. If approved, a waiting period of up to six months for pre-existing conditions may be imposed before the new policy fully covers those specific conditions, unless you had prior creditable coverage to reduce or eliminate it.

While federal law allows medical underwriting outside of guaranteed issue periods, some states have implemented more consumer-friendly rules. These state-specific protections might include annual open enrollment periods, “birthday rules,” or continuous guaranteed issue provisions that allow switching without underwriting. In most states, if you do not qualify for a guaranteed issue right, medical underwriting is a primary hurdle when attempting to switch Medigap plans.

Steps to Change Your Medigap Plan

Changing your Medigap plan involves practical steps to ensure a smooth transition and avoid gaps in coverage. Begin by thoroughly reviewing your current and anticipated healthcare needs, considering whether your existing plan still meets your requirements for benefits, cost-sharing, and network access.

Next, research and compare available Medigap plans and premiums from different insurers in your area. Medigap plans are standardized by letter, meaning the core benefits of a Plan G, for example, are identical across all insurers, though premiums can vary significantly. Compare benefits, insurer ratings, and customer service reviews.

Once you have selected a new plan, apply for it with the chosen insurance company. Do not cancel your current Medigap policy until your new plan has been officially approved and its effective date confirmed. Maintaining your existing coverage until the new one is active prevents gaps in your supplemental insurance protection.

After receiving approval for the new plan, confirm its start date and ensure all details are accurate. Only then should you contact your previous Medigap insurer to cancel your old policy. This careful sequence ensures continuous coverage.