- Medigap Open Enrollment is a one-time window to buy Medigap coverage without being denied or charged higher premiums due to health conditions.
- Outside the enrollment period, insurers can deny coverage or charge higher premiums due to health issues. You may still get coverage under Guaranteed Issue Rights in specific situations.
- A Medigap insurance specialist can provide personalized guidance and expert advice to help you choose the best plan for your needs.
If you’re approaching Medicare eligibility or already enrolled, you’ve probably heard about Medigap (Medicare Supplement) policies. These plans help cover the “gaps” in Original Medicare coverage, such as copayments, coinsurance, and deductibles. But timing is everything when it comes to enrolling in Medigap.
Here’s a look at everything you need to know about Medigap open enrollment to ensure you make informed decisions about your healthcare coverage.
Medigap Open Enrollment
Medigap, also known as Medicare Supplement Insurance, provides extra protection against unexpected medical bills, making it an essential choice for many seniors.
The Medigap Open Enrollment Period is a one-time window when you can purchase Medigap coverage without worrying about being turned down or paying higher premiums due to health conditions. This period is critical to securing affordable coverage and peace of mind for your healthcare needs.
Enrollment for People Over the Age of 65
If you’re 65 or older and eligible for Medicare, the Medigap Open Enrollment Period begins the first day of the month you turn 65, as long as you’re also enrolled in Part B of Medicare. This period lasts for 6 months, giving you plenty of time to explore different Medigap plans and choose the one that best fits your needs.
During this time, you can apply for any Medigap policy, and insurers are not allowed to deny you coverage based on your health or pre-existing conditions. Your plan options and premiums will likely be more favorable during this period, so it’s a great time to secure coverage.
Enrollment for People Under the Age of 65
If you’re under 65 and qualify for Medicare due to a disability, you can apply for Medigap coverage once you’re enrolled in Part B. However, the situation is a bit more complicated. In many states, insurers are not required to sell you Medigap coverage if you’re under 65. If you do manage to buy a policy, the premiums may be significantly higher than for those over 65.
Some states have laws that require insurers to offer Medigap policies to individuals under 65, though this varies from state to state. It’s worth checking what options are available in your area.
Buying Medigap Outside the Enrollment Period
If you don’t apply during the 6-month window, you may have to wait until another time, and insurers can turn you down or charge you higher premiums if you have health issues. If you’re in need of coverage, you might have limited choices, especially if you have a pre-existing condition.
Guaranteed Issue Rights
During specific situations, insurance companies must sell you a Medigap policy and cannot deny coverage due to pre-existing conditions. These rights guarantee your ability to buy a Medigap policy without medical underwriting in specific situations, such as:
- Losing Employer Coverage: If you lose your employer-sponsored health insurance, you typically have a guaranteed issue right to buy a Medigap policy.
- Moving Out of a Medicare Advantage Plan: If you leave a Medicare Advantage plan within the first 12 months of joining, you have a guaranteed issue right to return to Original Medicare and buy a Medigap policy.
- Other Qualifying Events: There are other situations where you may have guaranteed issue rights, such as if your insurance company goes bankrupt or misleads you.
It’s crucial to understand your guaranteed issue rights, as they can be your ticket to getting Medigap coverage even if you miss open enrollment.
Pre-Existing Condition Waiting Periods
Medigap policies may come with a waiting period for pre-existing conditions. It’s a common concern for many people, especially if you’re switching from other coverage or signing up for Medigap outside the Open Enrollment Period. This waiting period can last up to six months, but it depends on whether you had creditable coverage before enrolling in Medigap.
Creditable vs. Non-Creditable Coverage
Creditable coverage refers to health insurance that pays benefits similar to Medicare, like:
- Group health plans from employers or unions
- COBRA coverage
- Federal Employees Health Benefits (FEHB) Program
- Individual health insurance policies
If you had creditable coverage for at least six months before Medigap, with no breaks in coverage longer than 63 days, the Medigap insurer must reduce or eliminate the waiting period.
On the other hand, non-creditable coverage doesn’t count toward reducing your waiting period. It includes stand-alone prescription drug plans, hospital indemnity policies, specified disease policies, and Veterans Affairs (VA) benefits.
Why Partner with a Medigap Insurance Specialist
Choosing the right Medigap plan can be complex, especially with all the different plan options and enrollment rules. That’s where a Medigap insurance specialist can be invaluable.
Here’s how they can help:
- Personalized Guidance: Your healthcare needs, financial situation, and long-term goals are unique, and your Medigap plan should reflect that. A specialist will take the time to assess your medical history, current coverage, and potential future needs before recommending the most suitable Medigap policy. Whether you require frequent doctor visits, specialized treatments, or simply want peace of mind with minimal out-of-pocket expenses, they’ll tailor their recommendations to fit your lifestyle.
- Expert Advice: Medigap plans might all follow federal guidelines, but the fine print can be tricky to navigate. A specialist will break down the complexities of Medigap policies, explaining what’s covered, what’s not, and how different plans stack up against each other. They’ll clarify the differences between standardized plans like Plan G, Plan N, and others, ensuring you fully understand your options.
- Plan Comparison: A specialist will shop around on your behalf, comparing plans from multiple insurers to find the best balance of affordability and comprehensive coverage. They’ll also help you understand how premium costs may change over time and whether any added benefits—such as foreign travel emergency coverage—are worth considering based on your lifestyle.
- Ongoing Support: Whether you need assistance filing claims, have questions about coverage changes, or want to explore a different plan during a future enrollment period, they’ll be there to help. Additionally, if Medicare rules or Medigap policies change, they’ll keep you informed so you can make timely adjustments to your coverage.
Medigap open enrollment is a critical time for Medicare beneficiaries. It’s your chance to secure comprehensive coverage that can protect you from unexpected healthcare costs and give you peace of mind. If you want more guidance on Medigap, our team at HealthMarkets Insurance – Eric Zawicki can help you find the best value without sacrificing coverage. Contact us today!
