How to Change Medigap Plans: A Step-by-Step Guide

Medigap, also known as Medicare Supplement Insurance, helps individuals with Original Medicare manage their out-of-pocket healthcare costs. These private health insurance plans cover many expenses that Medicare Parts A and B do not, such as deductibles, copayments, and coinsurance. As healthcare needs and financial situations evolve, many individuals consider changing their existing Medigap policy. This guide outlines the process for changing your Medigap plan, detailing the conditions under which you can switch and the steps involved.

Understanding Your Rights to Change

Changing a Medigap plan involves specific periods and rights that influence whether an insurer can deny coverage or charge higher premiums based on health. Understanding these conditions is important before initiating any change. The most favorable time to acquire a Medigap policy is during your initial Medigap Open Enrollment Period.

This one-time, six-month period begins the first month you are 65 or older and enrolled in Medicare Part B. During this window, insurers cannot deny you coverage, impose waiting periods for pre-existing conditions, or charge higher premiums due to your health status. This “guaranteed issue” right ensures you can purchase any Medigap policy without medical underwriting.

Once this period ends, medical underwriting typically applies, meaning insurers can assess your health. Certain situations, however, can trigger “guaranteed issue rights” even outside your initial open enrollment period. These rights mean an insurer must sell you a Medigap policy, cover pre-existing conditions, and cannot charge more due to your health.

Examples include losing employer-sponsored group health coverage that paid after Medicare, or if your Medicare Advantage plan leaves its service area or stops providing coverage. Other guaranteed issue situations arise if you move out of a Medicare Advantage plan’s service area, or if your Medigap plan’s company goes bankrupt and you lose coverage.

Trial rights also allow you to switch back to Original Medicare and buy a Medigap policy if you tried a Medicare Advantage plan for the first time and want to revert within 12 months. These rights have specific timeframes, often 63 days from the qualifying event, during which you must act to secure your new policy without underwriting.

Key Considerations Before Applying

Before applying for a new Medigap plan, evaluate several factors to ensure the chosen policy aligns with your needs and budget. Medigap plans are standardized across most states, identified by letters such as Plan G or Plan N. This means a Plan G from one insurance company offers the exact same benefits as a Plan G from another.

The primary differences between same-letter plans from various insurers are the premiums, customer service quality, and the company’s reputation and financial stability. Once you decide on a specific plan letter that meets your coverage needs, your focus shifts to comparing prices and insurer reliability. Obtain quotes from multiple carriers to find the most competitive premium for your desired plan.

Medigap premiums can vary significantly based on the insurer’s pricing method, which includes attained-age, issue-age, or community-rated. Attained-age policies base premiums on your current age, meaning they start lower but increase as you get older, often with annual adjustments.

Issue-age policies set premiums based on your age when you first purchase the policy, and while these premiums may increase due to inflation, they do not rise simply because you age. Community-rated policies charge the same premium to all policyholders in a specific geographic area, regardless of age, which can offer predictable costs.

Beyond pricing structure, premiums can also differ based on your geographic location and the insurer’s overall pricing strategy. Reviewing your individual healthcare needs and how a new plan’s cost structure might affect your long-term budget is important.

The Application and Transition Process

With a clear understanding of your rights and a new Medigap plan selected, the next step involves the application and transition process. Begin by identifying insurers offering your desired Medigap plan letter in your area. Resources like state insurance department websites, the Medicare Plan Finder tool on Medicare.gov, or independent insurance brokers can help compare available plans and provide contact information.

When completing the application for a new Medigap policy, you will provide personal information, details about your current Medicare coverage, and potentially health information. If you are not exercising a guaranteed issue right, the insurer conducts medical underwriting. This involves answering health questions on the application, and the insurer may request medical records or conduct a phone interview to assess your health.

During medical underwriting, the insurer evaluates your health to determine eligibility and premium rates. Based on this assessment, the insurer can approve your application, approve it with a higher premium, or deny coverage if your health conditions pose a significant risk. For those applying under guaranteed issue rights, this underwriting process is bypassed, ensuring acceptance regardless of health.

Upon approval, the insurer sends policy documents and confirms the effective date. Wait until this new policy is confirmed and active before canceling your old Medigap plan. This prevents coverage gaps and avoids paying for two policies simultaneously.

Once your new policy is active, contact your previous Medigap insurer to cancel your old plan. Notify them in writing or by phone; they may require a specific form or cancellation letter. Most policies continue through the month for which you have already paid premiums.