One of the only times you have guaranteed rights to a Medicare supplement plan
(also called a Medigap plan) is during your Medigap Open Enrollment Period.
Your unique Medigap Open Enrollment Period begins six months prior to your 65th birthday and ends six months after your 65th birthday.
During this time, no Medigap insurance carrier can reject your application for any reason, which includes pre-existing conditions. You are not subject to medical underwriting during this Initial Enrollment Period.
Your age and health condition when buying a Medigap policy may impact which Medigap plan you select. (You may enroll later than 65 if you have postponed Medicare Part B coverage because you have other creditable health insurance.)
Of course, your current needs may not be the same for the rest of your life, so there are a few reasons you may want to switch Medigap plans.
In this article we will discuss what medical underwriting is and when it can affect your Medigap coverage. We’ll also talk about how to change your Medigap plan without going through medical underwriting.
Reasons You May Want to Switch Medigap Plans
The need to switch plans is not uncommon. As individuals age, their healthcare needs also change. While it is beneficial to already have a plan that addresses those increased needs, it is still possible to change your plan after enrolling.
Let’s discuss some reasons why you may want to switch your Medigap plan.
- You don’t need the benefits it offers.
In this case, you signed up for benefits that you are paying for but have no need for. As stated earlier, you may want to consider keeping this plan for future needs, but if finances are an issue, you may want to consider downgrading to a less expensive policy that offers less coverage.
- You need more benefits.
This is the most common reason to change Medigap plans. When individuals initially enroll in a Medigap plan,
which was probably around age 65, they may not have had the medical needs that they have today.
A cheaper plan with less coverage is appealing early on, but it may not be enough later in life.
- You want to change your insurance company.
Medigap plans are standardized. That means that Plan F is Plan F, no matter which carrier you purchase it from. The plan remains the same; the only difference is the premium individuals pay.
If your current carrier continues to raise its premium year after year, you may find that your carrier is charging much more than other companies.
- You want a policy that costs less.
While Medigap plans will never change, prices will increase as individuals age. After several years, individuals may find that they can no longer afford the policy.
When Guaranteed Issue Rights Apply
No matter in which part of the United States you reside, you have guaranteed issue rights to a Medigap policy under the following seven instances.
- You are enrolled in a Part C Medicare Advantage plan that is being discontinued altogether or in the area where you reside.
- You have Medicare Parts A and B plus a group policy and that group policy is ending.
- You have Medicare Parts A and B, as well as a Medicare Select policy, but you are moving from the coverage area.
- You signed up for a Part C or PACE (Program of All-Inclusive Care for the Elderly) less than one year ago and decide to switch. (This is called you “Trial Right.”)
- You switch from a Medigap plan to a Part C plan, but want to switch back in less than one year. (Also part of your “Trial Right.”)
- Your Medigap policy is canceled, unrelated to any fault of your own.
- You end your current coverage with either a Medigap or Medicare Advantage carrier because you were misled by the company or they broke policy rules.
If any of these apply to your situation, you may change Medigap plans without having to pass medical underwriting.
States with Unique Policies
There are a few states with added guaranteed issue rights.
In Maine, you may switch your Medigap supplement if you have had less than 90 days in a coverage gap since you first enrolled in a Medigap policy.
In Oregon and California, you may switch Medigap plans 30 days prior to your birthday or 60 days after your birthday, every year. This applies if the new plan has the same or less coverage than your current plan.
Missouri has a similar rule, but it revolves around the anniversary of your Medigap enrollment. Medigap policyholders may switch their Medigap carrier for 60 days around their initial enrollment anniversary. Note that this does not apply to switching plans but switching carriers only. This allows the member to switch to a carrier with a cheaper premium.
Connecticut, New York, and Washington may have the most advantageous guaranteed issue rights. There, members may switch Medigap plans at any time and are guaranteed issuance with no medical underwriting.
What if I can’t afford my current plan but don’t pass medical underwriting?
If there is no way for you to afford your current plan, but you do not have the benefit of skipping medical underwriting, you still have some options.
You may need to switch to a Part C Medicare Advantage plan. If you live in a rural area, this may mean that you have difficulty finding providers in your area and you may need to travel for care.
While not ideal, you must remember that some coverage is better than no coverage at all.