When can I buy a Medigap?

Dear Clara, 

When to buy a Medigap policy is an important, and sometimes confusing question. There are only certain times when Medigap insurers must sell you a policy and cannot charge you more because of your health history. Federal law sets some of these times for everyone in the country, and some states have additional protections.  

I’ll describe the federally protected times, but you should also check with your State Health Insurance Assistance Program (SHIP) to learn about Medigap enrollment rules in your state.   

Open enrollment period 

The best time to enroll in a Medigap policy is usually during your Medigap open enrollment period. Under federal law, you have a six-month open enrollment period that begins the month you are both 65 or older and enrolled in Medicare Part B. 

During your open enrollment period, Medigap companies cannot deny you coverage. They also must sell you a policy at the best available rate regardless of your health status. Best available rate means you have a lower premium, which is the amount you pay monthly to have the Medigap. The best available rate may be different depending on your age, your gender, whether you smoke, if you are married, and where you live. The rate should not be based on your health history.  

If you purchase a Medigap during your open enrollment period, insurers may give you a waiting period before covering conditions you had before you were enrolled. They must shorten the waiting period if you had certain types of coverage before you signed up.

Guaranteed issue right 

If you don’t buy a Medigap during your open enrollment period, you can also buy a Medigap when you have a guaranteed issue right. If you are 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 Medigap policy at the best available rate, regardless of your health status, and they can’t deny you coverage. If you have a guaranteed issue right, Medigap policies cannot impose a pre-existing condition waiting period on your coverage.  

You may have a guaranteed issue right if: 

• You, through no fault of your own, lost a group health plan (GHP) that covered your Medicare cost-sharing (meaning it paid secondary to Medicare) 

• You joined a Medicare Advantage Plan when you first became eligible for Medicare and disenrolled within 12 months 

• Your previous Medigap policy, Medicare Advantage Plan, or PACE program ends its coverage or commits fraud 

Buying a Medigap outside protected enrollment periods 

You may have fewer options if you try to buy a Medigap policy outside a protected enrollment period. For example, companies can refuse to sell you a policy or have certain medical requirements. If a company does agree to sell you a policy, you might have to pay a higher monthly premium and have a six-month waiting period before the Medigap will cover pre-existing conditions.  

In some states, however, there are additional open enrollment or guaranteed issue periods. Be sure to contact your SHIP to learn about the Medigap rules specific to your state and get help comparing Medigap plans. Visit www.shiphelp.org to contact your SHIP.  

Hope this answers your question! 

-Marci