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by Patricia Barry, AARP Bulletin, January 25, 2010
Q. I’ve had a medigap policy for several years, but I’d like to change to another. Is this possible? What if I have preexisting medical conditions? When is open enrollment?
A. As a Medicare beneficiary age 65 or older, you can buy Medicare supplemental insurance (also known as medigap) at any time. There are no annual enrollment periods for medigap. But with very few exceptions, the only time you can buy it with full federal guarantees and protections is during a very specific time frame—within six months of enrolling in Part B. During this period, an insurer cannot deny coverage or require higher premiums based on your age, health status or preexisting conditions.
Outside that six-month time frame, however, insurers can legally apply all these practices, which are collectively known in the insurance business as “medical underwriting.” However, some states offer more consumer protections than federal law does. (Your state’s department of insurance can give you information on its requirements for medigap policies.)
Why would you want to change policies? Perhaps you already have one of the 12 standardized medigap policies, which are labeled A through L, and are considering upgrading to one that has a more expensive set of benefits or switching to one that has fewer benefits and that costs less. Or perhaps you’re not happy with your current insurer, or want to switch to another company that you think might charge you less.
In any of these situations, it’s important to understand the possible consequences of switching policies or insurers before you opt out of your current medigap policy. Under federal regulations, Medicare officials say, the insurer:
Cannot exclude preexisting medical conditions from your coverage, or require waiting periods before coverage kicks in, if your current policy has been in effect for six months or longer.
Can temporarily deny coverage for any additional benefits that are offered under the new policy but not included in your current policy—but for no more than six months after the new policy goes into effect.
Can require you to pay higher premiums based on your current age and health status.
Can refuse to sell you a new policy.
In contrast, if you remain with the federally guaranteed medigap policy you bought within six months of enrolling in Part B, the insurer must continue to renew your policy every year, without any changes to its benefits and regardless of how your health changes, as long as you continue to pay the premiums.
Other circumstances when you retain federal guarantees
You can use a medigap policy only if you’re enrolled in the traditional Medicare program. If, instead, you’re in a private Medicare Advantage (MA) health plan (such as an HMO or PPO), you have the right to switch to the traditional program and buy a medigap policy with full federal guarantees and protections in these specific circumstances:
If you joined an MA health plan when you first became eligible for Medicare at age 65 and you are still within your first 12 months in this plan.
If you are within the first 12 months of being enrolled in an MA health plan and this is the first Medicare health plan you’ve ever been in.
If you are in an MA health plan (regardless of how long you’ve been enrolled) and the plan goes out of business or withdraws from Medicare and you choose to switch to traditional Medicare instead of enrolling in another MA plan.
In all these situations, you can apply to an insurer for a medigap policy up to 60 days before your MA plan’s coverage is due to end. But you must apply within 63 days of it ending to be entitled to full guarantees and protections under federal law.
Patricia Barry is a senior editor at the AARP Bulletin.
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