MEDICARE SUPPLEMENT OPEN ENROLLMENT

MEDIGAP PURCHASING DETAILS: ENROLLMENT PERIODS, GUARANTEED ISSUE, AND MORE

• It is important to know about protected times to buy a Medigap so you can time your enrollment wisely. Here we talk about federally protected times to purchase a Medigap.

Be aware that this information only pertains to protections that apply nationwide. 

Some states have other protections that give their residents additional opportunities to enroll in a Medigap. Be sure to call your State Health Insurance Assistance Program (SHIP) or State Department of Insurance to ask about state-specific Medigap rights.

OPEN ENROLLMENT PERIOD

Generally, the best time to enroll in a Medigap policy is during your open enrollment period. Under federal law, you have a six-month open enrollment period that begins the month you are 65 or older and enrolled in Medicare Part B.During your open enrollment period, Medigap companies must sell you a policy at the best available rate regardless of your health status, and they cannot deny you coverage. The best available rate may depend on a number of factors, including your age, gender, whether you smoke, your marital status, and where you live. To ensure that you are getting the best available rate, you may want to check with your SHIP. If you purchase a Medigap during your open enrollment period, policies are limited in their ability to exclude coverage for pre-existing conditions, meaning conditions you had before you enrolled.

GUARANTEED ISSUE RIGHT

If you miss your open enrollment period, you can also buy a Medigap when you have a guaranteed issue right. If you are age 65 or older, you have a guaranteed issue right within 63 days of when you lose or end certain kinds of health coverage.When you have a guaranteed issue right, companies must sell you a Medigap policy at the best available rate, regardless of your health status, and cannot deny you coverage. The best available rate may depend on a number of factors, including your age, gender, whether you smoke, your marital status, and where you live. A guaranteed issue right also prevents companies from imposing a waiting period for coverage of pre-existing conditions. Check with your SHIP to help ensure that you are getting the best available rate for your Medigap.
You may have a guaranteed issue right if:

• You, through no fault of your own, lost a group health plan (GHP) that covered your Medicare cost-sharing (meaning it paid secondary to Medicare)
• You joined a Medicare Advantage Plan when you first became eligible for Medicare and disenrolled within 12 months
• Or, your previous Medigap policy, Medicare Advantage Plan, or PACE program ends its coverage or commits fraud

Note: If you have a Medicare Advantage Plan, Medicare SELECT policy, or PACE program and you move out of the plan’s service area, you also have the right to buy a Medigap policy. 

However, many Insurers have recently stopped offering Medigap Plan G as a Guaranteed Issue plan for those who move or switch over from a Medicare Advantage plan.  This is due to many people realizing they may have a Health Issue around the corner and the Insurance Companies want to do everything they can to limit their risk exposure.  If this happens to you you can apply for just about any other Medicare Supplement plan and still have Guaranteed Issue rights or you will need to submit a Plan F or Plan G application to underwriting.

Be sure to keep a copy of any letters, notices, postmarked envelopes, and claim denials in case you need proof that you lost or ended health coverage. Medigap insurers may require these documents before they sell you a policy.

BUYING A MEDIGAP POLICY OUTSIDE OF REGULAR ENROLLMENT PERIODS

Unlike Medicare Advantage Plans you can apply for a new Medicare Supplement Plan anytime during the year.  However, please remember that the only time you will EVER have a Guaranteed Issue Medicare Supplement plan is that 7 month period when you first become eligible for Medicare.  That time is also referred to as your IEP or Initial Enrollment Period.

Anytime after that first selection, anyone applying for a new Medicare Supplement Plan, regardless of which plan you are applying for, you will be subject to underwriting.  What does that mean exactly?  Good question,  that means that you will have to answer questions such as your Height, Weight, Medical History, etc . and the company can choose to accept you or decline you for any reason.  This is why it is so important when you first join a Medicare Supplement to try to envision the best plan for you at that time and over the next 10-20 years.

CANCELLING A MEDIGAP POLICY

You have the right to review a new Medigap policy for the first 30 days. You can cancel it within that time for a full refund if it does not meet your needs.After the first 30 days, you can cancel your policy at any time. However, be careful when cancelling. Depending upon where you live, you may not be able to buy another policy, or companies may charge you more because of your health.