Kathryn Pomroy
Medigap plans, also called Medicare Supplement Insurance, is additional insurance you can buy from private health insurance companies to help pay your share of out-of-pocket costs, such as copays and deductibles, associated with original Medicare. Generally, you must have original Medicare, Part A and Part B, to buy a Medigap policy.
A Medigap policy pays out after both you and Medicare have paid your share of the medical costs. However, unlike Medicare, there are circumstances when insurance companies factor in preexisting conditions when deciding whether to offer you a Medigap policy or when setting premiums. In some cases, Medigap will also cover emergency medical expenses if you travel outside of the U.S.
Although there are ten Medigap plans available — A, B, C, D, F, G, K, L, M, and N — some of these plans C, F, E, H, I and J are no longer available to new enrollees in Medicare. However, if you are already enrolled in one of these plans, you can keep it - for now. If you were eligible for Medicare before January 1, 2020, you can still buy Plan C or F.
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In some states it's possible to buy another type of Medigap policy called Medicare SELECT. This type of policy lets you switch to a standard Medigap policy within 12 months if you change your mind and no longer want this type of coverage. If you live in Massachusetts, you only have two plans to chose from. In Minnesota, there are three plans. In Wisconsin, Medigap plans are standardized another way, but offer additional benefits such as coverage for certain preventive services, according to Medigap.com.
Medigap open enrollment only happens once
You get a six-month “Medigap Open Enrollment” period that starts the first month you have Medicare Part B and you’re 65 or older. During this period, you have what is called 'guaranteed issue rights' that protect you from denial of coverage for preexisting conditions and higher premiums. An insurance company can’t use medical underwriting to decide whether to accept your application or upwardly adjust your costs.
Keep in mind that after your Medigap open enrollment period is over an insurer can deny you coverage if you don’t meet their medical underwriting requirements, and you may have to pay more and there may be fewer options for you to consider.
Remember, the Medicare open enrollment period is October 15 to December 7.
How preexisting conditions can affect your Medigap eligibility
Many people don’t realize that even though preexisting conditions can’t affect your ability to get other types of health insurance, such as Medicare, the rules are very different for Medigap policies.
You can pick any Medigap plan available in your area within six months after you initially sign up for Medicare Part B. But after that, Medigap insurers in almost all states can reject you or charge more based on your health.
Until then, it can be challenging to switch to another insurer with better Medigap rates or if you had a Medicare Advantage plan for more than a year and want original Medicare and a Medigap policy instead.
States where insurers can't deny Medigap coverage after your initial enrollment period
Four states — including Connecticut, Maine, Massachusetts and New York — have special rules that let residents switch Medigap plans regardless of preexisting conditions.
Other states permit you to change plans at certain times. For example, if you live in California, you can select a different Medigap plan that has the same or fewer benefits if you make a decision to change within 30 days after your birthday each year.
You may also buy a Medigap policy without concern about preexisting conditions if you move out of your Medicare Advantage plan’s service area or change your mind within 12 months of signing up for Medicare Advantage at age 65. For more information see When Can I Buy Medigap?
By the way, if you currently have a Medicare Advantage Plan, it’s illegal for someone to sell you a Medigap policy. But, if you are considering switching to original Medicare, you can change plans during the Medicare Open Enrollment Period each year.
Also, your insurer may let you switch to a less-comprehensive policy regardless of your health (such as switching from a Plan F to a high-deductible Plan F). See the Medicare Rights Center’s list of what each type of Medigap policy entails.
And if you’re healthy, you may still be able to qualify for a new Medigap policy, especially if you’re in your mid-to-late sixties. But the best time to buy a policy is during your six month Medigap open enrollment period — a one-time enrollment period and doesn’t repeat every year — and starts the first month you have Medicare Part B and you’re 65 or older. After that, you might not be able to buy a Medigap policy, or it may cost more.
Resources to help find a Medigap policy
For more information about your state’s rules, check out www.naic.org/map. Most states have consumer guides that list Medigap prices and provide information for seniors searching for a plan. Your State Health Insurance Assistance Program can also help. See www.shiptacenter.org for links.
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