If you’re new to Medicare Supplement (Medigap) coverage, here are the most important things to keep in mind before joining a plan.
When joining a Medicare Supplement plan, one of the most important things you can do is enroll during the Medigap Open Enrollment Period. This is the six-month period when you can join any Medigap plan with guaranteed-issue rights, meaning insurance companies can’t turn you down for coverage or charge you more because of your health status. Your Medigap Open Enrollment Period starts automatically when you’re 65 and have Medicare Part B.
Outside of this period, it may be difficult to join a Medigap plan or switch plans with guaranteed issue. The insurance company is allowed to turn you down because of your health status, require medical underwriting, or make you pay a higher premium.
In spite of your best efforts, you can’t always plan for every health need or financial situation. You may want to switch Medicare Supplement plans if your current plan is too expensive, you’re paying for unnecessary benefits, or you find yourself needing more benefits than your plan covers.
If you do need to switch, see if you qualify for guaranteed-issue rights. There are limited situations where you may be able to switch Medigap plans with guaranteed issue and outside of your Medigap Open Enrollment Period. These include, but may not be limited to:
If you have a guaranteed-issue right, the Medicare Supplement plans available to you may vary depending on your situation. You may only be able to enroll in certain plans with guaranteed issue.
For example, you have certain protections if you enroll in a Medicare Advantage plan for the first time, but switch back to Original Medicare within the first year. In this case, you may have a right to enroll in a Medicare Supplement plan if you dropped your Medigap policy to enroll in Medicare Advantage. In this situation, you can enroll in the same Medigap plan you had previously if the same insurance company you had previously still offers it. Otherwise, you have a right to enroll in a Medigap Plan A, B, C, F, K, or L that is offered by any insurance company in your state.
Medicare Supplement benefits can only be used with Original Medicare, so some people drop their Medigap coverage if they switch to Medicare Advantage. For more information, see this article on guaranteed-issue protections when switching Medigap plans.
If you’re thinking of changing Medicare Supplement plans, you may not realize that you have 30 days to try out a new Medigap plan while keeping your original policy; this is known as your “free look period.” Here’s how it works: When applying for a new Medigap plan, you must agree on your application that you’ll cancel your original policy after the 30 days. Then, you have a month to try out your new plan and decide if you want to keep it. If after 30 days, you like your new policy and decide to keep it, you can cancel the first plan. Or, if you’d rather stay with your original policy, you can cancel the second policy. You’ll have to pay premiums for both policies for that one month.
This trial period is an important benefit because once you drop your Medigap policy, you may not always be able to get it back if you don’t have guaranteed-issue rights. During your “free look period”, you can try out a new plan without worrying that you won’t be able to get back your original plan if the new policy doesn’t end up working out (this right ends after 30 days).
Although most states offer 10 standardized Medigap plan offerings, the rules may be different depending on where you live, and insurance companies aren’t required to offer all 10 plan types. If you live in Wisconsin, Massachusetts, or Minnesota, the Medicare Supplement plans have different standardized benefits.
Also, insurance companies aren’t required to sell Medigap plans to individuals under 65. However, some states offer at least one Medicare Supplement policy for people under 65 who may qualify for Medicare because of end-stage renal disease or disability. Contact your state’s insurance department to see what the rules are in your state.
Insurance companies use different methods to calculate premiums, and the method they use affects how much you’ll pay for premiums both now and in the future. For example, some insurance companies use community-rated pricing, meaning everyone pays the same premium cost, regardless of age. Other insurance companies use attained-age pricing, where premiums are based on your current age. A Medigap plan that uses an attained-age method can cost more for members who join when they’re older.
Some insurance companies can make you wait up to six months before covering your pre-existing conditions. This waiting period can apply even if you apply during your Medigap Open Enrollment Period. During this waiting period, you’ll have to pay for the full out-of-pocket cost of health services to treat your health condition. After this period is over, the Medicare Supplement plan will cover your pre-existing condition.
If you’re joining a Medicare Supplement plan and you have health problems or disabilities, the insurance company can’t refuse to cover them if you have guaranteed-issue rights. However, it can make you wait to be covered.
Perhaps even more so than other types of Medicare coverage, it’s worth it to shop around. The biggest difference between Medigap plans of the same type will be the price, since most states require insurers to sell the same standardized benefits across each plan type, with the exception of Medigap plans in Massachusetts, Minnesota, and Wisconsin (which have their own set of standardized plans). This means the benefits will be exactly the same, regardless of insurer. However, insurance companies aren’t required to offer every single Medicare Supplement plan, and availability will depend on your location.
In other words, if you’re going to be getting the same Medigap coverage, researching plans lets you get those benefits for the best price. If you’d like to compare Medicare Supplement plans in your area now, just use the plan finder tool on this page to get started. Or, feel free to give us a call if you’d like personalized help with a licensed insurance agent.
To learn about Medicare plans you may be eligible for, you can: