When Can You Change Your Medigap Plan?

Medigap plans are policies sold by private companies to help cover some healthcare costs that Original Medicare does not. These costs can include deductibles, copayments, and coinsurance. Medigap policies are standardized, meaning a Plan G from one insurer offers the same basic benefits as a Plan G from another, though premiums can vary.

Understanding Medigap Enrollment Periods

The Medigap Open Enrollment Period (MEP) is a one-time, six-month window for most individuals. This period begins the first month someone is 65 or older and enrolled in Medicare Part B. During this time, federal law mandates that insurers must sell any Medigap policy they offer, regardless of health status, and cannot deny coverage or charge higher premiums due to pre-existing conditions.

After this initial six-month period, changing Medigap plans becomes more complex. Outside of the MEP, insurance companies can use medical underwriting. This means they can ask health questions, review medical history, and potentially deny coverage or charge higher premiums based on an applicant’s health. Moving or changing plans after the MEP requires qualifying for specific protections, unless state-specific rules apply.

Guaranteed Issue Rights for Plan Changes

Federal law provides specific situations, known as “Guaranteed Issue Rights,” where individuals can purchase a Medigap policy without medical underwriting. These rights are exceptions to the general rule that allows insurers to consider health status. When a guaranteed issue right applies, insurers cannot deny coverage, impose a waiting period for pre-existing conditions, or charge higher premiums based on health.

One common scenario is losing employer group health coverage, including COBRA, that supplemented Medicare. In such cases, individuals have 63 days from the date their coverage ends to enroll in a Medigap plan under guaranteed issue rights. Another instance is if a Medicare Advantage Plan leaves the Medicare program, stops service in one’s area, or if an individual moves out of the plan’s service area.

Trial rights also provide guaranteed issue opportunities. If someone joins a Medicare Advantage Plan when first eligible for Medicare and disenrolls within the first 12 months, they have a right to switch to a Medigap policy. Similarly, if a Medigap policy was dropped to join a Medicare Advantage Plan for the first time, and the individual disenrolls from the Medicare Advantage Plan within the first year, they may return to their previous Medigap policy or choose certain other plans. Guaranteed issue rights also apply if a Medigap insurance company goes bankrupt or if coverage ends through no fault of the policyholder. The application window for exercising guaranteed issue rights is typically 63 days from the date coverage ends or a qualifying event occurs.

State-Specific Medigap Rules

While federal law establishes baseline Medigap protections, individual states can implement their own rules that offer additional opportunities to change plans. These rules vary significantly by state.

For example, several states have adopted a “Birthday Rule.” This rule allows individuals to switch Medigap plans around their birthday without medical underwriting, usually to a plan with equal or lesser benefits. The specific timeframe for this rule varies by state, often ranging from 30 to 63 days around the birthday.

Some states, such as New York, Connecticut, and Maine, offer continuous guaranteed issue rights, allowing individuals to switch Medigap plans at any time without medical underwriting. Additionally, many states require Medigap plans to be offered to individuals under 65 who are on Medicare due to disability, although federal law does not mandate this. Individuals should consult their State Health Insurance Assistance Program (SHIP) or state insurance department for details specific to their location.

The Process of Changing Medigap Plans

Once an individual determines eligibility to change their Medigap plan, the process involves several steps. The first step is to research new plans and compare available options. Individuals can compare different standardized plans, such as Plan G or Plan N, and evaluate premiums offered by various carriers.

After selecting a new plan, the application process follows. If applying under a guaranteed issue right or a state-specific rule, health questions may not be asked, ensuring acceptance regardless of medical history. Outside of these protected periods, medical underwriting will occur, and an insurer may decline the application or charge a higher premium.

Upon approval, the new insurer will provide confirmation and specify the effective date of the new policy. A “free look” period, usually 30 days, allows individuals to review their new policy and cancel it for a full refund if it does not meet their needs. During this free look period, it is advisable to keep the old policy active and pay both premiums. The final step involves properly canceling the existing Medigap policy after the new policy is confirmed and effective.