When Can I Change My Medicare Supplement Plan?

Medicare Supplement plans, often known as Medigap, are insurance policies sold by private companies designed to help cover certain out-of-pocket healthcare costs that Original Medicare (Part A and Part B) does not pay. These expenses can include copayments, coinsurance, and deductibles, which can accumulate significantly during medical care. Medigap policies work in conjunction with Original Medicare, meaning that after Medicare pays its share for covered services, your Medigap policy then pays its portion. Understanding when and how changes to these plans can be made is valuable for beneficiaries to ensure their coverage aligns with evolving healthcare needs and financial considerations.

Your Initial Medigap Enrollment Period

The most opportune time to acquire a Medicare Supplement plan begins with your initial Medigap Open Enrollment Period. This six-month window starts in the month you turn 65 and are enrolled in Medicare Part B. For example, if you turn 65 and your Part B coverage begins on July 1, your Medigap Open Enrollment Period would last from July 1 through December 31.

During this period, insurance companies cannot deny you a Medigap policy or charge you higher premiums. They cannot use medical underwriting, a process where insurers assess your health for eligibility or rates.

This initial enrollment period guarantees access to any Medigap policy sold in your state. You have the broadest selection of plans and the most favorable pricing, ensuring that health status does not become a barrier to comprehensive supplemental coverage. Missing this six-month window can significantly alter your options, often making it more challenging and potentially more expensive to obtain a Medigap policy later.

If you do not purchase a Medigap policy during this initial open enrollment period, insurance companies have the right to use medical underwriting when you apply. They can ask health questions, review your medical history, and potentially deny coverage or charge higher premiums. Securing a policy during this initial period is the most straightforward and cost-effective approach.

Guaranteed Issue Rights for Plan Changes

Certain specific events provide Medicare beneficiaries with guaranteed issue rights, allowing them to purchase a Medigap policy without medical underwriting. These rights are time-sensitive, lasting for a limited period, 63 days from the date coverage ends or a notice is received.

One common scenario involves changes to existing coverage, such as when your Medigap insurance company goes bankrupt or leaves your service area. If your Medigap policy is canceled through no fault of your own or you move out of its service area, you have a guaranteed issue right to enroll in a new Medigap policy.

You also have rights if you leave a Medicare Advantage plan under specific circumstances. For instance, if you joined a Medicare Advantage plan when you first became eligible for Medicare and decided to switch back to Original Medicare within the first 12 months, or if your Medicare Advantage plan stops serving your area or you move out of its service area, you have a guaranteed issue right. The right extends for 63 days after your Medicare Advantage plan coverage ends.

Guaranteed issue rights also apply if your employer group health plan, including COBRA, or retiree health plan that paid after Medicare ends. This ensures that beneficiaries transitioning from employer-sponsored coverage to Medicare can secure supplemental insurance without health-related obstacles. The same protections apply if you drop a Medigap policy because you were misled or the company violated federal rules.

Under guaranteed issue rights, you are able to purchase Medigap Plans A, B, C, F, K, L, M, or N. However, if you became eligible for Medicare on or after January 1, 2020, Medigap Plans C and F are not available for purchase, even with guaranteed issue rights. The specific plans available can be more limited depending on the triggering event, but core plans like Plan A are an option.

Changing Plans Without Guaranteed Issue Rights

If your initial Medigap Open Enrollment Period has passed and you do not qualify for a guaranteed issue right, you can still apply for a new Medigap policy at any time. However, the application process involves medical underwriting. The insurer evaluates your health status, impacting coverage offers or premiums.

During medical underwriting, you will be required to answer detailed health questions on the application. The insurance company may also request access to your medical records or require a medical examination. Based on this assessment, the insurer has the discretion to accept your application, deny coverage, or offer you a policy with a higher premium due to pre-existing conditions.

Considering a change without guaranteed issue rights involves weighing the potential benefits against the risks. While you might seek a new plan for lower premiums or different benefits, your current health status is a significant factor. If you have developed health conditions since your initial enrollment, you face the possibility of being denied coverage by a new insurer or being charged substantially more.

It is advisable to secure approval for a new Medigap policy before canceling your existing one. This strategy prevents a gap in supplemental coverage should your application for a new policy be denied or offered at an undesirable rate. This approach provides a safety net, ensuring continuous protection against out-of-pocket medical expenses.

State-Specific Medigap Enrollment Rules

While federal guidelines establish Medigap enrollment periods and guaranteed issue rights, some states offer additional protections that expand opportunities for beneficiaries to change plans. These state-specific rules can provide more flexibility, allowing individuals to switch Medigap policies without medical underwriting under circumstances not covered by federal law. Investigate your state’s specific regulations.

One common state-specific provision is the “Birthday Rule,” which exists in several states. This rule allows Medigap policyholders to switch to a different Medigap plan with the same or lesser benefits from their current insurer around their birthday each year. During this period, lasting 30 to 60 days, medical underwriting is waived. This offers an annual opportunity to adjust coverage without fear of denial due to health.

A few states implement continuous open enrollment for Medigap plans. In these states, beneficiaries can change their Medigap policy at any time without facing medical underwriting. This offers the greatest degree of flexibility, as health status does not factor into the ability to switch plans, regardless of when the change occurs. Such continuous enrollment periods are an advantage for policyholders.

Some states also offer an annual guaranteed issue period, which might differ from the federal guaranteed issue rights. These state-mandated periods allow individuals to change Medigap plans during a specific timeframe each year, without medical underwriting. These additional protections underscore the importance of consulting state insurance departments or qualified insurance counselors to understand all available options for changing Medigap policies.