There are protections to keep in mind when you first buy a Medicare Supplemental (Medigap) Insurance policy or if your health coverage changes.
Best Time to Buy a Medigap Policy
The best time to buy a Medigap policy is during your open enrollment period. Once you sign up for Medicare Part B, you have six months to buy any Medigap plan. This six month period is called the open enrollment period and is offered one time only. During these six months, an insurance company can't turn you down or charge you more because of your past or present health problems. After your open enrollment period ends, insurance companies may have the right to turn you down, not let you buy the plan you want or charge you a higher premium (monthly cost).
You may be protected from being turned down for the plan you want if:
- you qualify for special Medigap protections under federal law or
- you live in a state that has expanded the Medigap open enrollment period
The Medigap protections are explained in the next section. Your state insurance department can tell you if your state allows you to buy a Medigap policy at any other time.
FYI: If you are under 65 and have Medicare due to a disability, you don't have a Medigap open enrollment period until you turn 65. However, some states require insurers to offer Medigap plans to you. Contact your state insurance department.
Medigap Protections
Pre-Existing Conditions
If you had a health problem before you bought your Medigap insurance, the insurance company may refuse to cover this health problem for up to six months. An insurance company can only impose this waiting period if the health problem was diagnosed or treated during the six months before your Medigap plan began.
You may also have a waiting period if you switch to a Medigap plan with more benefits. In this case, the waiting period would be for the extra benefits. For example, if you switch from Plan C to Plan F, you might have a waiting period before you begin getting the Medicare Part B excess charge benefit.
Some states have a different set of rules about the six-month waiting period. If you have a pre-existing condition, check with your state insurance department.
You may be protected from having a pre-existing conditions waiting period if:
- You buy a policy during your open enrollment period and have had at least six months of previous health insurance. In this situation, the insurance company can't impose any waiting period. If you had less than six months of health insurance, the waiting period will be reduced by the number of months you had the insurance. It is very important that you tell the company selling Medigap policies about your previous health insurance coverage.
- You want to switch Medigap insurance companies, change
Medigap plans at the same insurance company, or both, and:
- you have had a Medigap policy for at least six months, and
- you buy a plan that covers the same or lower level of benefits
Your Right to Buy a Medigap Policy
Under federal law, you may have special protections that give you the right to buy a Medigap policy after your open enrollment period. These Medigap protections often go into effect when your health insurance changes. For example, you are in a Medicare Health Maintenance Organization (HMO) that leaves your area and you decide to go back to the Original Medicare Plan. If you want to buy a Medigap plan to cover the gaps in Original Medicare, you have the right to:
- buy one of several Medigap plans,
- not to be charged more, and
- be covered for all pre-existing conditions
FYI: Whenever your health insurance changes, be sure to keep copies of any letters, notices or claim denials you get. You should even keep the post-marked envelope these papers came in, to show when you received them.
There are a number of situations when you can by a Medigap policy after your open enrollment period. Three of the most common situations when you can buy a Medigap policy after the open enrollment period ends are explained in Buying a Medigap Policy After the Open Enrollment Period.
AARP Resources
Understanding Medicare, Medigap, and Medicaid
AARP explains how these programs work.
State-by-State,
Plan-by-Plan List of Pharmacy Assistance Programs
Prescription discount programs offered by states, drug makers,
discount cards and discount pharmacies.
Guide to Health
Insurance for People with Medicare: Choosing a Medigap
Policy
Information about Medigap plans, what they cover and how to
choose the best policy.
Medicare
Personal Plan Finder
Information on the insurance companies selling Medigap policies
in your area and the range of premiums they charge.
Prescription
Drug Assistance Programs
Lists programs that offer free or low cost prescription drugs
and Medicare and Medigap plans in your area that offer
prescription drugs.
State
Health Insurance Assistance Program (SHIP)
How to contact your State Health Insurance Assistance Program
(SHIP), an important Medicare partner. Free one-on-one health
insurance counseling to people with Medicare. Lists of Medigap
insurance companies often available.
National
Association of Insurance Commissioners (NAIC)
Link to your state insurance department Web site which often
lists names and phone numbers of the companies selling Medigap
plans in your state.
