When Can I Change Medicare Supplement Plans?

Medicare Supplement (Medigap) plans cover costs Original Medicare doesn’t, like deductibles, copayments, and coinsurance. Private insurance companies provide these plans, designed to work alongside your Medicare Part A and Part B benefits. While Medigap plans generally provide stable coverage, specific times and circumstances allow individuals to change their plans. Understanding these periods ensures appropriate coverage.

Changing Plans with Medical Underwriting

Changing a Medicare Supplement plan often involves medical underwriting after an individual’s initial Medigap Open Enrollment Period. This six-month window begins the month a person is both 65 or older and enrolled in Medicare Part B. During this period, insurers cannot deny coverage or charge higher premiums due to health. Outside this period, medical underwriting usually applies unless a guaranteed issue right exists.

Medical underwriting is a risk assessment conducted by insurance companies. They review an applicant’s health status, medical history, and prescription drug use to determine the likelihood of future claims. This evaluation helps insurers decide on policy offers, premiums, and pre-existing condition waiting periods.

Outcomes vary. Applicants may be approved, but face higher premiums due to health. Insurers may deny coverage if health conditions are too high a risk. A waiting period of up to six months for pre-existing conditions may also be imposed, unless the applicant maintained continuous creditable coverage.

Changing Plans with Guaranteed Issue Rights

Individuals can change Medicare Supplement plans without medical underwriting if they qualify for a guaranteed issue right. These rights mandate insurers to sell a Medigap policy to eligible individuals regardless of health status. Insurers cannot deny coverage, impose waiting periods for pre-existing conditions, or charge higher premiums due to health issues. Generally, individuals have a 63-day window to exercise these rights, starting from the date their previous coverage ends or from the date they receive notice that their coverage will terminate, whichever is later.

One common scenario involves the involuntary loss of employer-sponsored group health coverage that supplemented Medicare. If this coverage, including COBRA, ends through no fault of the individual, a guaranteed issue right is triggered. The individual must provide proof of the loss of coverage, often through a letter from the former employer or plan administrator.

Another situation is when an existing Medigap or Medicare Advantage plan ends coverage or leaves its service area. If the insurer stops offering the plan, goes out of business, or the policyholder moves out of the service area, a guaranteed issue right applies. The plan must provide written notification of these changes, which serves as documentation.

Federal regulations also provide specific “trial rights” for individuals transitioning between Medicare Advantage and Original Medicare with a Medigap policy. One such right applies if someone initially joined a Medicare Advantage plan when first eligible for Medicare and decides to switch back to Original Medicare within the first 12 months.

A second trial right is available to individuals who dropped a Medigap policy to join a Medicare Advantage plan for the first time and then wish to switch back to Original Medicare within one year. In this instance, the individual may even have the option to return to their previous Medigap policy if it is still available.

Additional guaranteed issue rights cover unforeseen circumstances, such as if a Medigap insurance company goes bankrupt or commits fraud. If the insurer fails to meet its contractual obligations or misrepresents the policy, individuals are protected and can obtain new Medigap coverage.

Finally, individuals who leave a Medicare SELECT policy to enroll in another Medigap policy may also have a guaranteed issue right. Medicare SELECT plans often require the use of a specific network of healthcare providers for non-emergency services. This right allows beneficiaries to move to a standard Medigap plan without medical underwriting if their healthcare needs or preferences change. Specific Medigap plans available under guaranteed issue rights can vary, especially for those eligible for Medicare on or after January 1, 2020.

State-Specific Enrollment Protections

While federal regulations establish minimum standards for changing Medicare Supplement plans, some states offer additional protections and opportunities. These rules offer more flexibility than federal guaranteed issue rights. Regulations vary considerably by jurisdiction.

One notable state-specific protection is the “Birthday Rule” implemented in several states. This rule allows Medigap policyholders to switch from one Medicare Supplement plan to another without medical underwriting around their birthday each year. The specific window during which this can occur varies, typically ranging from 30 to 93 days, and often allows for a change to a plan with equal or lesser benefits.

A few states have gone further by offering continuous open enrollment periods for Medigap plans. In these jurisdictions, individuals can change their Medigap plan at any time throughout the year without being subject to medical underwriting.

State regulations also provide opportunities for individuals under 65 who qualify for Medicare due to disability or End-Stage Renal Disease (ESRD). While federal law doesn’t mandate Medigap plans for this group, many states require insurers to offer at least one, or all, Medigap plans to under-65 beneficiaries. Premiums for under-65 beneficiaries may still be higher in some states.

Given state variations, consult your state’s Department of Insurance or State Health Insurance Assistance Program (SHIP). These resources provide precise information about local regulations, enrollment periods, and additional protections. This ensures informed decisions about Medicare Supplement coverage.