When Can I Change My Medicare Supplemental Plan?

Medicare Supplement (Medigap) plans help cover out-of-pocket costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles. These plans are offered by private insurance companies and work in conjunction with your Original Medicare Parts A and B. While Original Medicare covers a significant portion of healthcare expenses, Medigap policies can provide more predictable healthcare costs by filling in some of the financial “gaps.” Understanding when and how you can modify your Medigap coverage is important.

The Initial Medicare Supplement Open Enrollment Period

The Initial Medicare Supplement Open Enrollment Period is a specific, one-time window for purchasing a Medigap policy. This period lasts for six months and begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. For example, if you turn 65 and your Medicare Part B coverage starts in May, your six-month open enrollment period would begin on May 1st and conclude at the end of October.

During this six-month window, you have a guaranteed right to buy any Medigap policy sold in your state. Insurance companies cannot use medical underwriting, meaning they cannot deny you coverage or charge you higher premiums based on your current health conditions or medical history. This protection ensures individuals can secure supplemental coverage regardless of pre-existing health issues.

This period is the most advantageous time to purchase a Medigap policy. Once this initial open enrollment period ends, insurers can apply medical underwriting, potentially leading to higher premiums, coverage denial, or waiting periods for pre-existing conditions.

Guaranteed Issue Rights for Plan Changes

Beyond the initial open enrollment period, specific situations grant individuals “guaranteed issue rights” to purchase a Medigap policy without medical underwriting. With a guaranteed issue right, insurance companies must sell you a Medigap policy, cannot use your health status to determine eligibility or pricing, and cannot impose waiting periods for pre-existing conditions. These rights protect consumers during certain life events.

Several common scenarios trigger these guaranteed issue rights. For instance, if your Medicare Advantage Plan leaves your service area, stops providing care, or you move out of its service area, you have guaranteed issue rights to switch back to Original Medicare and purchase a Medigap policy. A similar right applies if your employer-sponsored group health plan, which supplemented Medicare, ends. In these cases, you generally have a 63-day window to apply for a new Medigap policy, starting from the date your previous coverage ends.

Another guaranteed issue scenario, often referred to as a “trial right,” applies if you joined a Medicare Advantage Plan when you were first eligible for Medicare and wish to switch back to Original Medicare within your first year in the plan. If your Medigap insurer goes out of business or terminates your policy without cause, you are granted guaranteed issue rights to obtain a new Medigap policy.

Changing Plans Outside Guaranteed Windows

You can apply for a new Medigap policy even if you are outside your initial open enrollment period or a guaranteed issue situation. However, in such instances, insurance companies are permitted to use medical underwriting. This process involves a detailed review of your health history, including any pre-existing conditions, and may include health questions or a review of prescription history. Insurers use this information to assess the risk associated with providing coverage.

The implications of medical underwriting can significantly affect your ability to change plans. An insurer may deny your application if they deem your health history too risky, or they might charge you a higher premium based on your health status. Additionally, a waiting period for pre-existing conditions might be imposed before coverage for those conditions begins, typically up to six months. While you can apply at any time, approval is not guaranteed, and the cost could be substantially higher.

These factors underscore the importance of the initial open enrollment period and guaranteed issue rights. These specific windows offer protection from medical underwriting, ensuring access to a Medigap policy regardless of health.

Steps to Change Your Medicare Supplement Plan

To change your Medicare Supplement plan, begin by researching and comparing different Medigap plans (such as Plans A, B, D, G, K, L, M, and N) to understand their coverage and premiums. Standardized Medigap plans with the same letter offer the same basic benefits, regardless of the insurance company, but premiums can vary significantly. Resources like Medicare.gov or your state insurance department can assist in comparing options and finding companies selling policies in your area.

After identifying potential plans, contact the insurance companies directly to obtain quotes and application forms. If you are applying outside of a guaranteed issue window, be prepared for medical underwriting, which will involve answering health-related questions. It is important to complete the application accurately and provide any requested medical information.

Wait for approval of your new Medigap policy before canceling your existing one. This prevents any gaps in your coverage, which could leave you financially exposed to healthcare costs. Once you receive confirmation and the effective date for your new policy, you can then proceed to cancel your old plan.

Coordinate the effective date of your new policy with the cancellation date of your old one to ensure seamless coverage. Many insurers offer a “free-look” period, often 30 days, during which you can maintain both policies while ensuring the new one meets your needs. During this overlap, you would pay premiums for both plans.