It is important to know about protected times to buy a Medigap A Medigap is a supplemental health insurance policy that is sold by private insurance companies and works only with Original Medicare. Medigaps pay part or all of certain remaining costs after Original Medicare pays first. Depending on where you live and when you became eligible for Medicare, you have up to 10 different Medigap policies to choose from, each with a different set of standardized benefits. so you can time your enrollment wisely. Here we talk about federally protected times to purchase a Medigap.
Be aware that this information only pertains to protections that apply nationwide. Some states have other protections that give their residents additional opportunities to enroll in a Medigap. Be sure to call your State Health Insurance Assistance Program (SHIP) or State Department of Insurance to ask about state-specific Medigap rights.
Open enrollment period
Generally, the best time to enroll in a Medigap policy is during your open enrollment period. Under federal law, you have a six-month open enrollment period that begins the month you are 65 or older and enrolled in Medicare Part B.
During your open enrollment period, Medigap companies must sell you a policy at the best available rate regardless of your health status, and they cannot deny you coverage. The best available rate may depend on a number of factors, including your age, gender, whether you smoke, your marital status, and where you live. To ensure that you are getting the best available rate, you may want to check with your SHIP. If you purchase a Medigap during your open enrollment period, policies are limited in their ability to exclude coverage for pre-existing conditions, meaning conditions you had before you enrolled.
Guaranteed issue right
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 Medigap 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, your marital status, and where you live. A guaranteed issue right also prevents companies from imposing a waiting period for coverage of pre-existing conditions. Check with your SHIP to help ensure that you are getting the best available rate for your Medigap.
You may have a guaranteed issue right if:
- You, through no fault of your own, lost a group health plan (GHP) Group health plans (GHPs), also known as employer group health plans, are health insurance offered by an employer or employee organization (such as a union) for current or former employees and their families. This insurance may be primary or secondary to Medicare coverage depending on the size of the company and whether or not you are currently working. that covered your Medicare cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. (meaning it paid secondary to Medicare)
- You joined a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Â Plan when you first became eligible for Medicare and disenrolled within 12 months
- Or, your previous Medigap policy, Medicare Advantage Plan, or PACE program ends its coverage or commits fraud
Note: If you have a Medicare Advantage Plan, Medicare SELECT Medicare SELECT is a type of Medigap policy sold in some states that has a plan network. policy, or PACE program and you move out of the plan’s service area The service area is the geographic area where a Medicare Advantage Plan or Part D plan provides medical services to its members. In many plans, the service area is where your network of providers is located. , you also have the right to buy a Medigap policy.
Be sure to keep a copy of any letters, notices, postmarked envelopes, and claim A claim is a bill that health care providers submit to Medicare to ask for payment for services you received. Medicare Part A and Part B claims are processed by Medicare Administrative Contractors (MACs). Medicare Advantage Plan and Part D plan claims are processed by those private plans. See also: Medicare Administrative Contractor (MAC) and Durable Medical Equipment Medicare Administrative Contractor (DME MAC). denials in case you need proof that you lost or ended health coverage. Medigap insurers may require these documents before they sell you a policy.
Buying a Medigap outside protected enrollment periods
You may run into problems if you try to buy a Medigap policy outside a protected enrollment period. For instance, companies can refuse to sell you one or impose certain medical requirements. If a company does agree to sell you a policy, you may need to pay a higher monthly premium and be subject to a six-month waiting period before the Medigap will cover pre-existing conditions. Be sure to contact Medigap insurers in your state to learn if they will sell you a Medigap policy outside protected enrollment periods.
Cancelling a Medigap policy
You have the right to review a new Medigap policy for the first 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, or companies may charge you more because of your health.