When Can I Change Medigap Plans?

Medicare Supplement Insurance, known as Medigap, is a private health insurance policy that works with Original Medicare (Part A and Part B). It helps cover out-of-pocket costs Original Medicare does not, such as deductibles, copayments, and coinsurance. This article clarifies the periods and situations that allow you to modify your Medigap coverage.

Initial Medigap Enrollment and Rights

The most advantageous time to enroll in a Medigap policy is during your initial Medigap Open Enrollment Period. This six-month window begins the first month you are both age 65 or older and enrolled in Medicare Part B. During this period, insurance companies cannot use medical underwriting to assess your health. This means they cannot deny coverage, charge higher premiums based on pre-existing conditions, or impose waiting periods.

Exercising this right during your initial enrollment guarantees access to any Medigap policy sold in your state. This federal protection ensures your health status does not impact your ability to secure supplemental coverage. Missing this enrollment period can limit your future options and increase costs.

Standard Medigap Open Enrollment

Beyond the initial enrollment, some states provide annual opportunities to change Medigap plans without medical underwriting. These periods are sometimes called “birthday rules” or specific monthly windows, allowing existing Medigap policyholders to switch plans. These state-specific open enrollment periods vary by location, but they offer protection against denial of coverage due to health.

These state-specific Medigap enrollment periods differ from the federal Medicare Annual Enrollment Period (AEP). The AEP, from October 15 to December 7, primarily relates to Medicare Advantage and Medicare Part D plans, not Medigap policies. While the AEP allows changes to other Medicare coverage, Medigap changes under state-specific rules are separate.

Guaranteed Issue Situations

Certain circumstances grant individuals “guaranteed issue rights,” allowing them to purchase a Medigap policy outside their initial open enrollment period and without medical underwriting. These rights are federally mandated, ensuring access to coverage regardless of health. Such situations typically involve a loss of existing healthcare coverage.

Examples include losing employer group health coverage, including COBRA, that supplemented Medicare. You also gain guaranteed issue rights if your Medigap plan goes out of business or stops offering coverage in your area. Relocating outside your Medigap plan’s service area can also trigger these rights. Additionally, if you initially joined a Medicare Advantage Plan and disenroll within the first 12 months, or if your Medicare Advantage Plan violated its contract or misrepresented its benefits, you may have guaranteed issue rights to return to Original Medicare and enroll in a Medigap plan. These rights come with a limited timeframe, often 63 days, within which you must act to secure new coverage.

Changing Plans Outside Guaranteed Issue Periods

While protected enrollment periods and guaranteed issue rights offer opportunities to change Medigap plans without health scrutiny, it is possible to apply for a new Medigap policy at any other time. This process, however, involves medical underwriting. During medical underwriting, insurance companies evaluate your health history, including pre-existing conditions.

Insurers can ask health questions, review medical records, and based on their assessment, may deny coverage, charge higher premiums, or impose waiting periods for certain conditions. Applying for a Medigap plan outside of guaranteed issue periods does not assure acceptance, and the terms of coverage can be less favorable than those obtained during protected enrollment windows. It is advisable to utilize guaranteed issue periods whenever possible.

Steps to Change Your Medigap Plan

Once you determine eligibility to change your Medigap plan, several steps can guide the process. Begin by researching available plans in your area, using resources like Medicare.gov’s plan finder tool to compare benefits and premiums across different insurers. State Health Insurance Assistance Programs (SHIPs) also offer free, unbiased counseling to help you understand your options and compare policies.

After identifying a suitable new plan, contact the insurance company for a quote and to complete the application. Ensure the new policy is active before canceling your existing Medigap coverage to avoid any gaps in supplemental benefits. Most new policies become effective on the first day of the month following your application, though you can often choose a later start date. Once your new policy is confirmed and active, you can cancel your old Medigap policy.