When Can You Change Your Medigap Plans?

Medicare Supplement Insurance, commonly known as Medigap, provides coverage for some of the out-of-pocket costs not covered by Original Medicare, Part A and Part B. These costs can include deductibles, copayments, and coinsurance. Medigap plans offer stability in healthcare budgeting, but circumstances may arise where individuals may consider changing their existing plan. Changing a Medigap plan is not always straightforward, as specific rules and timings govern eligibility and cost.

Initial Enrollment and Its Importance

The Medigap Open Enrollment Period is an important 6-month window for individuals seeking supplemental coverage. This period begins the first month a person is 65 or older and enrolled in Medicare Part B. During this timeframe, insurance companies cannot deny coverage, impose waiting periods, or charge higher premiums based on an individual’s health status. This period represents a one-time opportunity for initial enrollment into any Medigap plan available in their state without medical underwriting.

This initial enrollment period highlights how easy it is to obtain a Medigap policy at the outset of Medicare eligibility. After this 6-month window closes, acquiring or changing a Medigap plan becomes more complex. The protections offered during this initial period, such as guaranteed issue and the absence of medical underwriting, do not automatically apply to later attempts to switch plans. This underscores why individuals often aim to secure their preferred Medigap policy during their initial enrollment.

Guaranteed Issue Rights for Changes

Certain situations, known as Guaranteed Issue Rights, allow individuals to switch Medigap plans or enroll in a new one without medical underwriting. These rights mean that insurers cannot deny coverage or charge more due to an individual’s health conditions. Individuals typically have a 63-day window to exercise these rights after a qualifying event, which often starts 60 days before the event.

One common scenario is losing employer-sponsored group health coverage that supplemented Medicare. If this coverage ends, individuals have a guaranteed issue right to enroll in a Medigap plan, provided they apply within 63 days of the coverage termination. This also applies if a Medigap policy is terminated through no fault of the policyholder, for example, if the Medigap plan goes out of business or leaves the market. In such cases, the individual has up to 63 days after their current Medigap coverage ends to secure a new policy.

Moving out of a Medigap plan’s service area also triggers a guaranteed issue right. For instance, if an individual moves to a new address outside their current plan’s service area, they can switch to a new Medigap plan. Similarly, if a Medicare Advantage plan is leaving the service area or the individual moves out of its service area, they qualify for a guaranteed issue right to switch back to Original Medicare and enroll in a Medigap plan. This right applies for 60 days before and up to 63 days after the Medicare Advantage plan coverage ends.

Another set of guaranteed issue rights relates to Medicare Advantage “trial rights.” For example, if an individual joined a Medicare Advantage plan when first eligible for Medicare and disenrolls within the first year, they have a right to switch back to Original Medicare and purchase a Medigap plan. This also applies if an individual dropped a Medigap policy to join a Medicare Advantage plan for the first time and then disenrolls within the first 12 months. These trial rights allow individuals to return to Medigap without medical underwriting.

Switching Plans Without Guaranteed Rights

When an individual wishes to change their Medigap plan but does not qualify for a Guaranteed Issue Right, the new insurance company can use medical underwriting. This process involves the insurer reviewing an applicant’s health information to decide whether to offer coverage and at what cost. Insurers may ask health questions about an applicant’s medical history, current conditions, and medications.

Based on this assessment, the insurance company may deny coverage, charge higher premiums, or impose a waiting period for pre-existing conditions. A waiting period means the new policy will not cover expenses related to certain pre-existing conditions for up to six months. This makes changing Medigap plans outside of the protected enrollment periods more challenging and carries the risk of denial or increased costs.