When Can I Change My Medicare Supplemental Insurance Plan?

Medicare Supplement (Medigap) insurance plans help manage healthcare costs for individuals enrolled in Original Medicare. These plans help cover out-of-pocket expenses that Original Medicare (Parts A and B) does not, such as copayments, coinsurance, and deductibles. Medigap plans are standardized with different lettered options (e.g., Plan A, B, G, N). The ability to change plans is governed by specific federal and, in some cases, state rules.

Understanding Guaranteed Issue Rights for Medigap

Guaranteed issue rights allow beneficiaries to purchase a Medigap policy without medical underwriting. This means insurers cannot deny coverage or charge higher premiums due to health status. These protections are important for individuals with health concerns who wish to change their Medigap coverage.

The most significant period for guaranteed issue is the Medigap Open Enrollment Period, a one-time, six-month window. This period begins the first month an individual is both 65 or older and enrolled in Medicare Part B. During this time, beneficiaries can purchase any Medigap policy available in their state without answering health questions.

Trial rights also trigger guaranteed issue protections. These apply if an individual joins a Medicare Advantage (MA) plan or Program of All-Inclusive Care for the Elderly (PACE) when first eligible for Medicare at age 65 and switches back to Original Medicare within 12 months. Another trial right applies if an individual drops a Medigap policy to join an MA or Medicare SELECT plan for the first time, then disenrolls from that MA or SELECT plan within 12 months.

Other situations grant guaranteed issue rights when an individual loses existing coverage through no fault of their own. For instance, if a Medicare Advantage plan leaves its service area, or an individual moves out of their MA plan’s service area, they gain the right to switch to a Medigap policy. This protection also extends to individuals whose employer group health plan, including COBRA coverage, that supplements Medicare ends.

Additional guaranteed issue events include when a Medigap policy issuer goes bankrupt or ceases to offer coverage, or if an individual leaves a Medicare SELECT policy because they move out of its service area. Guaranteed issue rights may also apply if a Medicare Advantage plan or a Medigap plan’s company misled the beneficiary or did not follow Medicare rules.

When exercising guaranteed issue rights, specific timeframes apply. In most cases, individuals have a 63-day period to apply for a new Medigap policy, starting from the date their previous coverage ends or they receive notification it will end. It is also possible to apply up to 60 days before existing coverage terminates to avoid gaps. Available Medigap plans under guaranteed issue rights include Plans A, B, D, G, K, L, M, or N for those eligible for Medicare on or after January 1, 2020. Individuals eligible before this date may also have access to Plans C or F.

Changing Medigap Plans Without Guaranteed Issue Rights

Changing a Medigap plan outside a guaranteed issue period involves medical underwriting. This is a review of an applicant’s health status, medical history, and other factors by the insurance company. This assessment helps insurers determine eligibility for coverage and establish premium rates.

During medical underwriting, applicants are required to answer detailed health questions. These may cover current conditions, past diagnoses, hospitalizations, medications, and lifestyle habits like tobacco use. Some insurers might also request access to medical records or a health examination to evaluate the potential risk.

The implications of medical underwriting can vary. An insurance company may approve the application, deny coverage, or offer a policy at a higher premium if the applicant has pre-existing health conditions. A waiting period for coverage of pre-existing conditions might also be imposed, meaning the new policy may not cover related costs for a certain period, up to six months.

Approval for a new Medigap plan through medical underwriting is not guaranteed. Individuals with significant health issues may find it challenging to switch plans or face higher costs. While federal rules govern Medigap, some states offer additional consumer protections, such as “birthday rules” or other specific enrollment periods. These allow individuals to change Medigap plans without underwriting during certain times of the year.

The Process of Switching Medigap Plans

Once eligibility to change Medigap plans is determined, either through guaranteed issue rights or medical underwriting, the transition process begins. The initial step involves comparing available Medigap plans. Beneficiaries should review the standardized benefits of each lettered plan (e.g., Plan G, Plan N) and compare premiums from various insurers. Official Medicare resources, such as Medicare.gov, provide tools for comparing plans and understanding coverage.

After selecting a new Medigap policy, the application process begins. If applying under guaranteed issue rights, provide verifiable documentation proving eligibility. This might include notices from a previous plan, proof of moving, or letters confirming loss of employer coverage. For applications involving medical underwriting, accurately answering all health questions is mandatory, as insurers may cross-reference information with medical and prescription drug databases.

Do not cancel an existing Medigap policy until the new policy is formally approved and confirmed as active. This prevents a gap in supplemental coverage, which could lead to unexpected out-of-pocket expenses. Maintaining continuous coverage protects against unforeseen healthcare costs during the transition.

Once the new Medigap policy is active, the previous policy can be canceled. Notify the former insurance provider in writing, stating the desired cancellation date. Retain copies of all correspondence for record-keeping.

Understanding the effective dates for new policies is important. A new Medigap policy becomes effective on the first day of the month following application and approval. Many policies include a 30-day “free look” period. During this time, a beneficiary can cancel the new policy and receive a refund if dissatisfied, provided their old policy is still in place. This period allows for a final review of the new coverage before fully committing.