When Can Medicare Supplement Plans Be Changed?

Understanding Medicare Supplement Plan Changes

Medicare Supplement Insurance, or Medigap, complements Original Medicare (Parts A and B). These private insurance plans are designed to help manage out-of-pocket costs, such as deductibles, copayments, and coinsurance, which are not fully covered by Original Medicare. Medigap policies are standardized across most states, meaning that a plan of the same letter offers identical basic benefits regardless of the insurance company or location. Understanding the specific conditions and timeframes for enrolling in or changing these plans is important for beneficiaries.

Initial Enrollment Opportunity

The primary period for enrolling in a Medicare Supplement plan is during an individual’s one-time, six-month Medigap Open Enrollment Period. This period begins in the month a person is both age 65 or older and enrolled in Medicare Part B. For example, if an individual turns 65 and their Medicare Part B coverage becomes effective on July 1st, their Medigap Open Enrollment Period would run from July 1st through December 31st.

During this specific six-month window, insurance companies cannot deny coverage or charge higher premiums based on an applicant’s health status or pre-existing conditions. Delaying enrollment beyond this period may lead to fewer plan options, higher costs, or even denial of coverage if medical underwriting is required.

This guaranteed access to coverage makes the initial enrollment period the best time for most people to secure a Medigap policy. Even if an individual has employer coverage that supplements Medicare, their Medigap Open Enrollment Period still starts with their Part B effective date, providing an opportunity to obtain coverage without health questions.

Guaranteed Issue Scenarios

Beyond the initial enrollment period, specific situations grant individuals “guaranteed issue rights,” allowing them to purchase a Medigap policy without medical underwriting. The timeframe for exercising these rights is limited, often to a 63-day window following a qualifying event.

One common scenario involves the involuntary loss of employer-sponsored group health coverage that supplemented Medicare, including COBRA coverage. If this coverage ends, individuals have a 63-day period to enroll in a Medigap plan. This protection helps ensure continuous coverage when a significant change in health benefits occurs.

Moving out of a Medicare Supplement plan’s service area also triggers guaranteed issue rights. This applies if an individual has a Medicare SELECT policy and moves outside its network, or if they move out of a Medicare Advantage plan’s service area and switch back to Original Medicare. The enrollment period starts 60 days before and extends up to 63 days after the prior coverage ends.

If a Medigap plan or Medicare Advantage plan leaves the market, stops providing coverage, or an insurer goes bankrupt, individuals are also granted guaranteed issue rights. The protected enrollment period spans 60 days before and 63 days after the termination date.

Individuals who joined a Medicare Advantage plan when first eligible for Medicare can switch back to Original Medicare and enroll in a Medigap plan within the first 12 months, known as a “trial right.” This allows a period to evaluate the Medicare Advantage plan’s suitability. A similar trial right exists for those who dropped a Medigap policy to join a Medicare Advantage plan for the first time; they can switch back to their previous Medigap policy within 12 months if it is still available.

State-Specific Enrollment Rules

While federal rules establish core enrollment periods and guaranteed issue rights, some states offer additional or different opportunities to change Medicare Supplement plans. These state-specific provisions can provide beneficiaries with greater flexibility beyond federal mandates. It is important for individuals to research the specific regulations in their state of residence.

A common state-specific rule is the “Birthday Rule,” adopted by several states. This rule allows individuals to switch Medigap policies around their birthday each year without medical underwriting. While the exact timeframe varies by state, it provides a window of 30 to 60 days for beneficiaries to change to a Medigap plan of equal or lesser benefits. This can be particularly useful for finding a more competitively priced plan.

Some states also have annual open enrollment periods specifically for Medigap plans, which differ from the federal Medigap Open Enrollment Period. These periods may allow individuals to change plans without medical underwriting, similar to the broader Medicare Annual Enrollment Period for other Medicare coverage types. A few states even offer year-round guaranteed issue rights, meaning individuals can enroll in or switch Medigap plans at any time without health questions. This continuous access offers significant protection and flexibility.