When is the best time to buy Medigap?

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Published October 22, 2022

| The best time to buy a Medicare supplement policy, also known as Medigap, is when you have what are called guaranteed protections — the right to buy any policy in your area at the best rates for someone your age, even if you have preexisting medical conditions. If you buy a Medigap policy at other times, insurers may reject you or charge more because of your past or current health.

If you’re 65 or older, the best time to buy Medigap is within the six-month period that starts the first day of the month when you enroll in Medicare Part B. This applies even if you choose to delay enrolling in Part B until you or your spouse stops working for an employer that provides health insurance.

The key here is “within six months.” Consider this six-month “open enrollment” period for Medigap as a one-time opportunity designated by federal law. If you enroll in Part B but allow more than six months to pass before buying Medigap, even if you disenroll from Part B because you return to work and have health insurance from your new employer, you’re not entitled to another open enrollment period for Medigap.

When are other good times to buy a Medigap policy?

If either you or your spouse is still working and has insurance from an employer with fewer than 20 workers, you usually have to sign up for Medicare Part A and Part B at age 65, even though you have employer coverage. In most cases, Medicare becomes your primary coverage at 65 and the employer’s coverage is secondary.

In that case, you may have signed up for Part A and Part B at age 65 but chosen not to sign up for a Medigap policy then because your employer’s coverage filled in Medicare’s gaps. You’re entitled to another Medigap open enrollment period when that coverage ends. In this situation, you can buy any Medigap policy regardless of preexisting conditions within 63 days of losing health insurance that provides secondary coverage. This would include retiree benefits, COBRA continuation coverage or insurance from a current employer with fewer than 20 workers.

You also have federal “guaranteed issue rights” to buy certain Medigap policies regardless of preexisting conditions in other situations. These could include:

Medicare Advantage changes. If you have coverage through a private Medicare Advantage plan rather than original Medicare, you have a guaranteed issue right if your Medicare Advantage plan leaves Medicare or stops offering care in your area or if you move out of the plan’s service area. In that case, you can switch to original Medicare and have the right to buy most Medigap policies within 63 days after your Medicare Advantage coverage ends.

Medicare Advantage trial rights. If you joined a Medicare Advantage plan when you were first eligible at age 65 and, within the first year, you decide to switch to original Medicare, then you have up to 63 days after that coverage ends to buy any Medigap policy sold in your state. If you dropped a Medigap policy to join a Medicare Advantage plan for the first time and you’ve been in that plan for less than a year, you can switch back to original Medicare and buy the Medigap policy you had before you joined the Medicare Advantage plan.

You also can switch to most other Medigap plans if your former policy isn’t available. You generally have a 63-day guaranteed issue right period, which can be longer in some situations.

The company doesn't follow the rules. You can buy most Medigap policies within 63 days from the date your Medicare Advantage or Medigap coverage ends if a company has misled you in the understanding of your coverage or it hasn’t followed the coverage rules.

Your Medigap coverage ends. If your Medigap insurance company goes bankrupt and you lose coverage or if your Medigap policy ends through no fault of your own, then you have a right for up to 63 days to buy most of the Medigap plans available in your area.

You may need to provide a copy of notices from the insurer showing that your coverage was terminated with your application for a Medigap policy to prove that you have a guaranteed issue right.

What are some special Medigap state protections?

Your state may have additional periods when you can buy Medigap policies regardless of your health. Three states — Connecticut, Massachusetts and New York — allow you to buy a Medigap policy at any time even with preexisting conditions. In these states, the Medigap insurers also must charge everyone the same rate regardless of age, called “community rating.”

And in Maine, for one month every year, insurers can offer Medigap Plan A, which provides the least amount of coverage, to state residents age 65 or older regardless of their health.

Several states allow people who already have Medigap policies to switch plans at certain times of the year regardless of their health. For example, in Oregon, you have 30 days after your birthday each year to switch to another Medigap plan with equal or lesser benefits, while in California you have 60 days after your birthday every year to do so. A few states also let you switch plans near your birthday or the anniversary of the date you purchased your policy.

You can find out more about each state’s rules from the State Health Insurance Assistance Program (SHIP). Most state insurance departments should have information about Medigap rules, and often lists of premiums by company, in your state.

What happens if I want Medigap outside open enrollment?

If you apply for a Medigap policy when you don’t have a guaranteed issue right, you’ll probably have to answer questions about your health. Insurers may reject you or charge you more if you’ve had medical conditions such as cancer, chronic kidney disease, congestive heart failure and rheumatoid arthritis. Though they may not reject you, they could charge you a higher rate if you have diabetes, high blood pressure or high cholesterol.

The specifics vary from company to company. Some will insure you if a certain period has passed since your illness or hospitalization.

You can find policies available in your area and the contact information for the insurers by using Medicare’s Medigap Plan Finder.

Keep in mind

65 or older? The federal guaranteed issue rules apply to you.

Younger than 65? If you qualify early for Medicare because of a disability and want to get a Medigap policy to help cover Medicare’s deductibles and copayments, you have no federal protections. However, many states have Medigap protections for people under age 65.

These rules can vary from state to state. Contact your state SHIP for more information.

Medicare Advantage may help. If you qualify for Medicare before age 65 but can’t get a Medigap policy in your state, you may be able to sign up for a Medicare Advantage plan after signing up for parts A and B.

Until recently, people with end-stage renal disease couldn’t enroll in Medicare Advantage plans. But those rules changed in 2021.

Disabled beneficiaries have a second chance. If you’re younger than 65 and unable to buy a Medigap policy right now or you qualify only for one that charges a very high premium, when you turn 65, the clock will reset.

You’ll be eligible for Medicare based on age instead of disability. Then you can choose any Medigap policy with full federal protections, but you must buy one within six months of your 65th birthday unless you live in one of the few states that allow you to purchase a Medigap policy at any time.

Updated October 21, 2022

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