When Can I Change Medicare Supplement Insurance?
Explore the specific timing and criteria that allow you to change your Medicare Supplement (Medigap) insurance policy.
Medicare Supplement Insurance, or Medigap, covers costs Original Medicare (Parts A and B) does not, such as deductibles, copayments, and coinsurance. Understanding when and how to change these policies is important for managing healthcare expenses. Changing Medigap policies is not always straightforward, often depending on specific enrollment periods or qualifying life events. This article explains the windows and conditions for Medigap plan changes.
Initial Medigap Open Enrollment Period
The most advantageous time to enroll in a Medigap policy is during your initial Medigap Open Enrollment Period. This six-month window begins the month you turn 65 and are enrolled in Medicare Part B. During this period, insurance companies must sell you any Medigap policy they offer, regardless of your health status.
Medical underwriting is not permitted, preventing insurers from denying coverage or charging higher premiums based on pre-existing health conditions. Additionally, they cannot impose waiting periods for pre-existing conditions. This one-time opportunity is beneficial for securing comprehensive coverage without health-related barriers. Missing this period can significantly impact your ability to acquire a Medigap policy.
Specific Guaranteed Issue Rights
Even after the initial Medigap Open Enrollment Period, certain situations grant “Guaranteed Issue” rights, allowing you to purchase or change Medigap policies without medical underwriting. These rights protect you when events change your health coverage. For instance, losing employer-sponsored group health coverage that supplemented Medicare generally grants a guaranteed issue right to enroll in a Medigap plan.
Another scenario involves Medicare Advantage Plans. If your Medicare Advantage Plan leaves or you move out of its service area, you have a guaranteed issue right to switch to Original Medicare and enroll in a Medigap policy. Similarly, if you tried a Medicare Advantage Plan for the first time and leave it within 12 months to return to Original Medicare, you often qualify for a guaranteed issue right. This allows you to try a Medicare Advantage Plan without losing your ability to enroll in a Medigap plan.
Furthermore, if your Medigap company goes bankrupt or misleads you, or if you move out of the service area of a Medicare SELECT policy, you receive guaranteed issue rights. These rights ensure you can obtain a Medigap policy when circumstances beyond your control necessitate a change in your coverage. These protections prevent insurers from denying coverage or charging higher rates due to your health history during these qualifying events.
Changing Plans Outside Guaranteed Issue Windows
If you wish to switch Medigap policies and neither your initial open enrollment period nor guaranteed issue situations apply, you lose your “Guaranteed Issue” rights. In such cases, insurers are allowed to use medical underwriting. This process involves reviewing health history, which can lead to significant challenges.
Under medical underwriting, an insurer can deny coverage, charge higher premiums, or impose waiting periods for pre-existing conditions based on health status. While a healthy individual might find a new plan at a reasonable rate, someone with existing health issues could face denials or increased costs. The risk involved in changing plans outside protected windows is considerable, as health can directly impact eligibility and premium.
Understanding and utilizing the initial Medigap Open Enrollment Period and specific guaranteed issue rights is important. These periods offer the most secure pathways to obtaining or modifying Medigap coverage without medical underwriting hurdles.