Medigap Medicare Supplement Plan Enrollment
Key Takeaways
- A Medicare Supplement plan (Medigap)Medicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you’ll need to pay. is an additional policy that covers gaps in Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
- Your six-month Medigap Open Enrollment Period starts the month you turn 65 and are enrolled in Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. .
- During your Open Enrollment Period, Medigap insurance carriers can’t deny coverage or charge higher rates due to pre-existing conditionsA pre-existing condition is an illness, injury or other medical condition you had before you enrolled in your health insurance policy. .
- You can switch Medigap plans, but you will no longer have guaranteed issue rights.
A Medicare Supplement (Medigap) plan helps with healthcare costs that Original Medicare doesn’t pay, like coinsurance, copayments, and deductibles. Nearly a quarter of Original Medicare beneficiaries also purchase a Medigap policy.
Here’s what you need to know about enrolling in or switching Medigap plans.
Am I Eligible for Medigap?
To be eligibleSome health plans require you to meet minimum requirements before you can enroll. for a Medigap plan, you must first enroll in Original Medicare (Parts A and B). Most U.S. adults are first able to join Original Medicare during their Initial Enrollment Period, which lasts for seven months around the time of your 65th birthday. People who are already receiving Social Security benefits when they become eligible for Medicare are are generally automatically enrolled. Otherwise, you can sign up online or over the phone through the Social Security Administration.
When Can I Enroll in Medigap?
The Medicare Supplement Open EnrollmentThe Medicare Open Enrollment Period (OEP), also known as the Annual Enrollment Period, runs from October 15 to December 7 each year and allows you to make multiple Medicare-related changes. In addition, Affordable Care Act Open Enrollment allows changes to non-Medicare coverage from November 1 to December 15. Period lasts for six months. This window begins the month when you are at least 65 years old and enrolled in Medicare Part B. You must meet both qualifications to be eligible for Medigap’s open enrollment period.
For example, if you turn 65 in January, but your Part B enrollment begins in February, your eligibility begins on Feb. 1 and runs through the end of July.
What Are Guaranteed Issue Rights?
During your Medigap open enrollment period, you have guaranteed issueIf you have guaranteed issue rights, insurance companies are required to sell you a Medigap (Medicare Supplement) policy without any additional conditions. rights. That means insurance carriers are required to accept your application for coverage and can’t charge you higher premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. because of pre-existing conditions or health status. Plus, your coverage is guaranteed renewable if you purchase it at this time, which means it can’t be canceled by the insurer as long as you pay your monthly premium.
You can still purchase Medigap after your open enrollment period, but you may not get the same pricing or coverage levels. Insurance carriers are allowed to charge more or limit your coverage for pre-existing conditions if you sign up outside of the initial Medigap open enrollment period.
There are a few exceptions, including if you move or must purchase new Medigap coverage. You may have guaranteed issue rights under these conditions:
- Medicare recipients who lose supplemental coverage through no fault of their own
- Retirees whose former employers cancel their coverage
- Medicare beneficiaries that move to a new state and can’t keep their supplemental coverage
- Beneficiaries who left a Medigap plan for a Medicare Advantage plan (which substitutes for Original Medicare coverage), but decide to return to Original Medicare and Medigap within 12 months of switching
Changing Your Medicare Supplement Plan
You may decide to switch Medigap plans because:
- Your current plan includes extra coverage you don’t need.
- You need additional benefits that are not covered under your current plan.
- You want to use a different insurance company.
- You want to save money by switching to a plan that costs less.
Technically, you can change plans at any time, but after your guaranteed issue rights lapse, your coverage options may be more limited and cost you more.
When can you switch from a Medigap plan to Medicare Advantage?
You cannot purchase a Medigap plan with a Medicare Advantage plan. Medicare Advantage plans are administered by private insurance carriers and substitute for Original Medicare coverage. These plans may include additional benefits and require you to see in-network healthcare providers to get the most out of your coverage.
If you have Original Medicare with a Medigap plan and want to switch to a Medicare Advantage plan, you do have this option. However, when you join Medicare Advantage, you will have to drop your Medigap plan.
The first time you leave Medigap to join a Medicare Advantage plan, you have 12 months to change your mind. During that trial period, federal law allows you to revert back to Original Medicare with Medigap. You can return to the Medigap plan you had, or if it’s no longer available, you can purchase a similar plan.
If you signed up for Medicare Advantage when you were first eligible and want to switch to an Original Medicare plan with Medigap, you have this option, too. In these cases, you should have the option of signing up for any Medigap plan, just as you would have during your initial enrollment period.
Can I change my mind about switching Medicare Supplement insurance plans?
When you sign up for a Medigap plan during the six-month open enrollment period, you can typically change your plan or coverage within that six-month window.
If you decide you want to switch plans after the six-month open enrollment period, you can sign up for a new plan and get a 30-day “free look” period. During this time, you will have to pay the premium for both your old plan and your new plan, but will have some time to decide which you want to keep. In some cases, once you drop your old plan, you may not be able to re-enroll.
FAQ
How do I know if I’m already enrolled in Medicare Part A?
Does Medigap cover my spouse?
Sources
- What’s Medicare Supplement insurance (Medigap)?. Medicare.gov.
- Guaranteed Issue rights. . Medicare.gov.
- Medigap Enrollment and Consumer Protections Vary Across States. KFF.org
- Social Security Office Locator. SSA.gov
- Switching Medigap policies.. Medicare.gov.
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