It’s important to know about protected times to buy a Medigap so you can time your enrollment wisely. Read on to learn about these protected times under national law.
Be aware that this section of Medicare Interactive does not discuss laws in each state. Some states allow people to enroll in Medigaps during more times. Be sure to call your SHIP and ask about your right to purchase a Medigap policy in your state. You also call your State Department of Insurance for more information.
The Best Time to Enroll
Aim to buy your Medigap during your open enrollment period to buy any Medigap policy offered in your state. Under national law, you have a six-month open enrollment period that begins the month you turn 65 and enroll in Medicare Part B. You can apply for a Medigap before this enrollment period, and your Medigap coverage will be effective the first day of the enrollment period.
During your open enrollment period, Medigap companies must sell you a policy at the best available rate regardless of your health status, and cannot deny you coverage. The best available rate may depend on a number of factors, including your age, gender, whether you smoke and where you live. To ensure that you are getting the best available rate, you may want to check with your state SHIP. If you purchase a Medigap during your open enrollment period, policies are limited in their ability to exclude coverage for pre-existing conditions or conditions you had before you enrolled.
Make sure you buy a Medigap in advance of enrolling in Medicare so you do not have any gaps in coverage. If you already had Part B when you turned 65, your open enrollment period to buy a Medigap policy begins the month of your 65th birthday.
Another Good Time to Enroll
If you miss your open enrollment period, you can also buy a Medigap when you have a guaranteed issue right. If you are age 65 or older, you have a guaranteed issue right within 63 days of when you lose or end certain kinds of health coverage.
When you have a guaranteed-issue right, companies must sell you a policy at the best available rate, regardless of your health status and cannot deny you coverage. The best available rate may depend on a number of factors, including your age, gender, whether you smoke and where you live. Companies cannot make you wait for coverage of pre-existing conditions if you have a guaranteed issue right. Be sure to keep a copy of any letters, notices, postmarked envelopes and claim denials in case you need proof that you have a guaranteed issue right because you lost or ended health coverage. Medigap companies may require these documents before they will sell you a policy.
Also, to ensure that you are getting the best available rate, you may want to check with your state SHIP.
You have a guaranteed issue right to buy most Medigap policies within 63 days of when you lose or end certain kinds of health coverage. This includes:
- If you had group health insurance (through either current or previous employment) that paid after Medicare and lost it through no fault of your own, you have the right to buy most Medigap policies.
- If you joined a Medicare Advantage plan when you first became eligible for Medicare and disenrolled within 12 months, you have the right to buy any Medigap policy offered in your state by any insurance company.
- If your previous Medigap policy, Medicare Advantage plan, PACE program ends its coverage or commits fraud, you have the right to buy most Medigap policies.
If you have a Medicare Advantage plan, Medicare SELECT policy or PACE program and you move out of the plan's service area, you have the right to buy most Medigap policies.
Buying a Medigap outside of Protected Enrollment Periods
You may run into problems if you try to buy a Medigap policy outside of your protected enrollment periods. Companies can refuse to sell you one or may only let you buy one if you meet certain medical requirements. If an insurance company does agree to sell you a policy you will probably need to pay a higher monthly premium and you may need to wait six months before the Medigap will cover pre-existing conditions.
Contact Medigap insurers in your state to find out if they will sell you a Medigap policy outside of protected enrollment periods.
Cancelling a Medigap Policy
You have the right to review a new Medigap policy for 30 days. You can cancel it within that time for a full refund if it does not meet your needs.
After the first 30 days, you can cancel your policy at any time. However, be careful when cancelling. Depending upon where you live, you may not be able to buy another policy. Even if you can, companies can charge you more because of your health.