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Medigap: It has a Guaranteed Issue Period

As previously mentioned, insurers must sell you any Medigap Plan they offer for the same price they charge people who are in good health during your Medigap open enrollment period.

That open enrollment period begins on the first day of the month in which you are BOTH at least 65 years old AND you are enrolled in Medicare Part B. Your open enrollment period typically lasts for six months, although certain states may have additional open enrollment periods that include people who are under 65.

If you miss your open enrollment period, insurers are not required to sell you a Medigap Insurance Plan unless you meet their medical underwriting requirements, with certain exceptions.

Your Medigap rights may depend on when you enroll in Medicare Part B. If you are at least 65 years old, your Medigap open enrollment begins when you enroll in Medicare Part B. It is typically better to enroll when you are first eligible for Part B so you avoid a Part B late enrollment penalty.

What If I Have Employer Coverage during Open Enrollment?

If you have health coverage through your employer or your spouse’s employer, you may wait to enroll in Medicare Part B. When that coverage ends, you will still have the chance to enroll in Part B without a late enrollment penalty.

In this situation, your Medigap open enrollment will begin when you are ready to enroll in Medicare Part B. If you enroll in Part B while you have coverage through an employer, your Medigap open enrollment would start and you would miss it unless you bought a Medigap Plan before you needed it.

More on Medigap Guaranteed Issue Periods

Any Medigap Plan is guaranteed to be renewable even after you develop health problems. Insurers cannot cancel your Medigap Plan solely because your health deteriorates as long as you continue to pay the premiums.

If you live in New York, all Medigap Plans for the state are guaranteed-issue plans regardless of your health problems. That makes it much easier to change plans.

You typically have a guaranteed right to buy a Medigap Plan when you lose your health coverage, or another major change occurs in your coverage. For example, insurers cannot refuse to sell you a Medigap Plan if your Medicare Advantage Plan is leaving Medicare or stops covering health care where you live, or you move outside the area where that plan has coverage.

In such situations, you have a right to buy Medigap Plans A, B, C, F, K or L if sold in your state only when you change to Medicare rather than a replacement Medicare Advantage Plan.

You can apply for a Medigap Plan as early as 60 calendar days before your existing coverage ends.

You must apply no later than 63 calendar days after your coverage has stopped. Remember that Medigap Plan coverage cannot begin until your Medicare Advantage coverage has ended.

Can I “Try Out” a Medigap Plan and Return it for a Refund?

When you purchase a Medigap Plan from MediGap Advisors, you have 30 days from the date you receive your policy in the mail to decide whether to keep it or return it for a full refund.

You also have a right to try a Medicare Advantage Plan, and choose to return it in order to buy a Medigap Plan.

What If I Have COBRA, Retiree or Union Coverage?

Your right to buy a Medigap Plan is guaranteed when you have Medicare and coverage through an employer (such as COBRA, retiree or union coverage) that comes to an end, and that was paying its share after Medicare. Certain states may also grant you additional rights in such situations.

In that case, you have a right to buy Medigap Plans A, B, C, F, K or L if these plans are sold in your state. If you have COBRA, you can buy a Medigap Plan immediately, or when COBRA ends.

In such situations, you must apply no later than 63 calendar days after whichever of the following events happen last:

  1. The date your coverage stops
  2. The date on your notice that your coverage is going to end
  3. The date on a denied claim, if this is how you learn that your coverage has stopped.

What If I Lose Coverage from a Medicare SELECT Policy?

If you have a Medicare SELECT policy and you move out of the SELECT service area, you are guaranteed the right to buy a Medigap Plan.

You have a right to buy a Medigap Plan A, B, C, G, K or L as long as these plans are sold in the state into which you move.

You can apply as early as 60 calendar days before your coverage stops. You must apply no later than 63 calendar days after your coverage ends, though.

Can I Drop a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly?

If you joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly when you were first eligible for Medicare Part A, you can still switch to Medicare within the first year.

In that situation, you have a guaranteed right to buy any Medigap Plan sold in your state.

You can apply for a Medigap Plan as early as 60 calendar days before your coverage stops, but you must apply no later than 63 calendar days after your coverage has ended.

In certain instances, you may have the right to buy a Medigap Plan for an additional 12 months.

Can I Switch to a Medigap Plan from an Advantage or SELECT Plan?

If you drop a Medigap InsurancePlan and replace it with a Medicare Advantage Plan or a Medicare SELECT policy for the first time and want to return to a Medigap Plan within the first year, you have a right to buy back the Medigap Plan you dropped.

With the 2010 changes to Medigap Plans, the same letter Medigap Plan you can now buy may differ from your previous plan. For example, none of the Medigap Plans now available include prescription drug coverage, although earlier versions did.

You can apply as early as 60 calendar days before your coverage ends, but you must apply no later than 63 calendar days after your coverage stops. Certain circumstances may extend to your right to buy a Medigap Plan by an additional 12 months.

What If I Lose Coverage through No Fault of Mine Own?

If you lose your coverage through no fault of your own (including when an insurer goes bankrupt), you have a guaranteed right to buy a Medigap Plan A, B, C, F, K or L if these plans are sold in your state.

You also have a guaranteed right to buy the same Medigap Plan, if sold in your state, when you drop a Medicare Advantage Plan or another Medigap Plan because an insurer failed to comply with applicable rules or misled you.

You must apply no later than 63 calendar days from when your coverage ends.

How to Exercise My Guaranteed Right to Buy a Medigap Plan

If you find that more than one of the above situations give you a guaranteed right to buy a Medigap Plan, exercise the right of your choosing. Remember that certain states may guarantee you additional Medigap rights.

It is very important to keep a copy of claim denials, e-mails, letters or notices as proof of your coverage. Save postmarked envelopes that such correspondence came in to verify the date of mailing.

When Can an Insurer Cancel My Medigap Plan?

An insurer can drop your Medigap Plan coverage if:

  1. You did not complete your application honestly
  2. You stop paying the premiums.

Are All Medigap Plans Guaranteed to Be Renewable?

Medigap Insurance Plans are typically renewable with the exception of certain Medigap Plans purchased before 1992.

If you purchased a plan prior to 1992 that is not renewable, you still have the right to buy another Medigap Plan. The newer plans may have different benefits even if they have the same name.

For example, while older versions of Medigap Plans included coverage for prescription drugs, that benefit is no longer included in any Medigap Plan.

NEXT: Medigap for Those Under 65 Years Old

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