Changing Medicare Supplement (Medigap) Plans

The best time for you to sign up for a Medicare Supplement plan, also called Medigap, is when you turn 65 and are covered under Medicare Part B. This six-month period, known as your Medigap Open Enrollment Period, typically starts on your 65th birthday if you’re already enrolled in Part B. During this period, you’re guaranteed acceptance into any Medicare Supplement plan available in your area without submitting to a complete medical review or being denied coverage because of pre-existing conditions. If you choose not to get Medicare Part B right away, then your Medigap Open Enrollment Period may also be delayed and will start automatically once you’re at least 65 and have Part B.

Your health status when enrolling in a Medigap plan can play an important role in which Medigap plan you choose, and your age at the time may determine how much you pay for it.

Like anything else, your needs are subject to change, so the plan you originally chose may not cover all of your needs for the rest of your life. There are numerous reasons for switching Medicare Supplement plans; some common ones are described below.

Your current Medigap plan provides more coverage than necessary

Are you paying for benefits that you don’t need and never use? Perhaps you’re in good health and don’t use all of your Medigap benefits. A cheaper plan may make more sense if this is the case.  Review the options in your area to find the best fit for your needs.

Out-of-pocket costs are too high

Let’s say you’re in poor health, and there’s another Medigap plan that will help you save more money. Switching Medicare Supplement plans may be difficult in this kind of situation if you’re outside your Medigap Open Enrollment Period. If you’re not turned down because of your health, you may have to wait up to six months to be covered for costs associated with a pre-existing condition, and you may be charged higher premiums for this coverage.

You may still be able to switch plans with guaranteed issue in certain situations. For example, if your Medigap company goes bankrupt or misled you, you may be able to change Medicare Supplement policies with guaranteed issue.

But some states have laws that make sure certain Medigap policies are always available. Check your state’s insurance website to see what’s available in your area. You might want to check different insurance companies to find out their rules for switching Medigap plans. There may be companies that sell guaranteed-issue plans. For personalized assistance, you can always contact eHealth to speak with a licensed insurance agent about your options.

Someone you know is paying less than you are for the same Medigap plan

Medicare Supplement plans are named with letters, such as Plan A, and standardized such that plans of the same letter name offer the same benefits. In most states, there are 10 Medigap plans — Plan A through Plan N (some plans, such as Plan E, are no longer sold). Massachusetts, Minnesota, and Wisconsin have their own versions of Medigap. In all other states, insurance companies must offer the same standardized benefits, but they can pick which of the 10 plan categories they want to offer and they can price the plans differently.

Any company that sells Medigap must offer at least Plan A. If the company sells more than one Medigap plan, it must next offer at least Plan C or Plan F.

Now that you know some of the basics, try to determine why your friend pays a different amount. He may have a policy through a different Medigap insurance company. How old is your friend? Did she switch policies, or has she had the same one since she was first enrolled?

Medigap insurers can set premiums in any of these ways:

• Attained-age rated–The premium is based on your current age and increases with your age.
• Entry-age-rated–The premium is set using your age when you first enroll.
• No-age rated–The premium is the same for everyone who has the same policy.

As mentioned, it’s worth noting that, depending on your health status, your success in changing Medigap plans is not always guaranteed. Once your Medigap Open Enrollment Period passes and you try to join a plan, the insurance company generally has the right to do a complete review of your medical history. The company may then decide to raise the costs of your policy or deny you coverage outright.

You have a Medicare Advantage plan and switch to Original Medicare with Medigap

Medigap and Medicare Advantage (Medicare Part C) plans don’t work together. If you drop your Medicare Advantage plan, and return to Original Medicare, Part A and Part B, you can apply for a Medigap plan, but getting the plan you want depends on the situation.

Consumer protection rules called “guaranteed-issue rights” make sure that you can get a Medigap policy in spite of any health condition you have, and at a rate that isn’t set higher due to your condition, in certain situations.

• If you had a Medicare Advantage plan for the first time, and for less than a year, this is considered your “trial right” period. You can switch back to Original Medicare and get the same Medicare Supplement plan you had before making the change (you have guaranteed-issue rights to the Medigap plan) if the same insurance company still sells your former plan.
  • If your former Medigap policy is no longer sold, you may be able to choose a different plan with guaranteed issue. You can enroll in a Medigap Plan A, B, C, F, K, or L offered by any private insurance company in your state.
• If you had the Medicare Advantage plan for more than a year, then there is generally no guaranteed-issue right under federal law that will let you rejoin the same Medigap policy you had. You may, however, be able to find acceptance to a plan by shopping around.
• Even if you had the Medicare Advantage plan for more than a year, if you lost coverage for certain reasons (for example, you moved out of the Medicare Advantage plan’s service area or the plan left Medicare or stops covering your service area) and you switch to Original Medicare, you have a guaranteed-issue right to Medigap plans A, B, C, F, K, or L offered by any private insurance company in your state.

The list above shows just a few of these situations. For more information, see this publication from the Centers for Medicare & Medicaid Services.

You have an older Medigap policy that’s no longer sold

You may wish to reconsider switching plans if this is your sole reason for changing plans. You don’t have to change plans just because the one you have is no longer offered.

For example, none of the 10 Medigap plans currently offered includes coverage for prescription drugs. If your Medigap plan does, then you may wish to hang on to it.

There are other reasons you may want to change plans, but you’re generally allowed to keep a discontinued Medigap policy, complete with its original benefits intact. Keep in mind that if you enrolled in your Medigap policy before 1992, your plan may not be guaranteed renewable and may cost more than the standardized plans currently available. If your Medigap insurance company decides not to renew your policy, you’ll have a guaranteed-issue right to enroll in a different Medigap plan.

Other points to keep in mind when switching Medigap plans

• If you decide to change Medigap plans, you have a 30-day “free look” period where you can temporarily carry both plans to see which one you like better. However, during this period, you’ll pay premiums on both plans, and you must cancel the first policy after the first month. Or, if you decide you’d rather stay with your original Medigap plan, you can cancel the second policy after the 30-day trial period.
• As mentioned above, you don’t need a Medigap plan when you have a Medicare Advantage policy. Medigap only covers out-of-pocket costs associated with Original Medicare, Part A and Part B.