Navigating the Medigap Open Enrollment Period: Key Tips

You are getting ready to turn 65 and enroll in Medicare Part B. You want to make sure you have good Medicare coverage for any medical expenses you might have. This means exploring Medicare supplement options, which help cover costs that Original Medicare doesn’t. But with so many important deadlines during this time, you might wonder, “When exactly can I buy Medigap?”. The answer is, thankfully, pretty simple: It’s all about your Medigap open enrollment period.

The Medigap open enrollment period is crucial for securing the right coverage for your needs. This is a one-time, six-month window during which you have guaranteed issue rights for Medigap policies. Knowing when it starts and your options can be incredibly beneficial in the long run. Understanding this period is essential when you buy Medigap.

What Is The Medigap Open Enrollment Period?

The Medigap open enrollment period begins the month you turn 65 and are enrolled in Medicare Part B. It’s like a golden ticket, giving you access to any Medigap plan—regardless of any health problems you might already have.

This means that insurance companies cannot refuse to sell you a policy during these six months and cannot charge you a higher premium because of a pre-existing condition.

These rights make this period a powerful opportunity for Medicare beneficiaries. Missing this enrollment period can make finding the right plan at a reasonable cost tricky. This highlights why taking advantage of it is essential for securing comprehensive coverage.

When Can I Buy Medigap?

As stated before, the Medigap open enrollment period is triggered by two key events: your 65th birthday and active enrollment in Medicare Part B. For many, this period naturally coincides with the first time they’re eligible to enroll in Medicare, offering a seamless transition into comprehensive coverage. However, you may be wondering “When does the Medigap open enrollment period start?” if you are still working.

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Retirement and Enrollment

The process is relatively straightforward for individuals who are already retired at 65. You can apply for a Medigap policy as soon as you have your Medicare card, typically a month or three before your 65th birthday. This head start allows for any processing time, ensuring your Medigap coverage starts the same month your Medicare benefits become active.

Also see: Can I change Medicare Supplement plans anytime?

Working Beyond 65 and Enrollment

Things are slightly different if you continue to work past 65 and have health insurance. If your employer has over 20 employees, you may delay joining Medicare Parts A and B. While delaying might seem beneficial, there’s a crucial detail: your Medigap open enrollment period is also postponed.

When you leave your job or your employer-sponsored health insurance ends, you’ll have an eight-month Special Enrollment Period to join Parts A and B. This period is when your Medigap open enrollment period will finally kick in, beginning the month you enroll in Part B.

Can I Change My Medigap Policy?

One of the most common questions about Medigap is if you can switch plans later. The Medigap open enrollment period offers guaranteed issue rights, but after it ends, things work differently.

Switching Outside Open Enrollment

Switching outside your Medigap open enrollment period might be difficult. Insurance companies may use medical underwriting, evaluating your health status before offering coverage. This could mean higher premiums, limited plan options, or even denials based on pre-existing conditions. In some situations, you may be subject to a pre-existing condition waiting period if you try to switch outside of the open enrollment period.

Possible Exceptions to Know About

However, certain situations allow Medigap changes outside the open enrollment with guaranteed rights. These are known as “guaranteed issue rights” or “Medigap protections”. For example, losing coverage due to an employer’s plan termination might grant you special enrollment rights for Medigap. Or, if you have end-stage renal disease, you have guaranteed issue rights. You may also have creditable coverage, which can shorten applicable waiting periods.

Understanding Guaranteed Issue Rights

Guaranteed issue rights act as safeguards, ensuring you aren’t denied Medigap coverage due to pre-existing health conditions during open enrollment. These rights primarily apply during your Medigap open enrollment period but can extend to specific situations afterward.

• Insurance companies can’t use medical underwriting to determine eligibility during your Medigap open enrollment.
• Pre-existing conditions cannot lead to coverage denial or increased premiums during this period.

While they are mainly associated with your Medigap open enrollment period, some states extend guaranteed issue rights to specific events beyond that window. Consulting your State Health Insurance Assistance Program (SHIP) is recommended to understand your state’s policies. Your SHIP can provide free Medicare assistance to help you understand your options.

State Law Variations

A few states have implemented legislation that makes it easier to switch from one plan to another and for people under age 65 to get Medigap coverage.

In Connecticut and New York, Medicare supplements are guaranteed issue all year long.

In Massachusetts, Medigap plans are guaranteed-issue to February through March.

California and Oregon have birthday rules that give enrollees a 30-day window following their birthday each year when they can switch Medigap plans without going through medical underwriting, but only if they are going to a plan with the same or lesser benefits.

In Maine, Medicare beneficiaries can switch to a different Medicare supplement plan with the same or fewer benefits anytime during the year. Also, all Medicare supplement carriers must designate one month each year when Plan A, the plan with the fewest benefits, is available as a guaranteed issue to everyone who qualifies.

Missouri has an anniversary rule that allows anyone with Medigap coverage a 60-day window around their plan anniversary each year, during which they can switch to the same plan, guaranteed issue, with another carrier.

If you are under 65 and eligible for Medicare due to a disability, Medicare supplement availability depends on the regulations in your state. There are no federal regulations or protections guaranteeing Medigap enrollment for people under 65.

Medigap and Medicare Advantage

It’s also important to understand that Medigap and Medicare Advantage don’t mix. It’s illegal for companies to sell you Medigap if you have Medicare Advantage. Medicare Advantage plans, or Medicare Part C, are alternatives to Original Medicare (Parts A and B).

Medigap is supplemental coverage designed to work with Original Medicare, filling gaps in cost-sharing like deductibles and copays. Choosing between these options is a crucial step in crafting your healthcare approach, each with pros and cons. You cannot have both, so exploring which coverage option suits your needs is important.

Important reading: Are Medicare Supplement plans worth it?

Conclusion

Your Medigap open enrollment period is more than a simple enrollment timeframe. It is your chance to get guaranteed Medigap coverage regardless of your health history. Use this time wisely and ensure your healthcare future is bright. Remember, this period starts as soon as you’re enrolled in Medicare Part B at 65 and only lasts six months.