How Preexisting Conditions Can Affect Medigap Insurance

Question: Is it true that an insurance company can factor in preexisting conditions when deciding whether to offer you a medigap policy or when setting the premiums?

Answer: That’s correct. Many people don’t realize that even though preexisting conditions can’t affect your ability to get other types of health insurance, the rules are different for medigap. 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. This can make it difficult if you’d like to switch to another insurer with better medigap rates or if you had a Medicare Advantage plan for more than a year and want traditional Medicare and a medigap policy instead.

There are a few exceptions. A few states—including Connecticut, 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, Californians may select a different medigap plan that has the same or fewer benefits if they do it within 30 days after their 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 Medicare.gov’s When Can I Buy Medigap?

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, for example). See the Medicare Rights Center’s list of what each type of medigap policy covers.

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. You don’t need to wait until any specific time of year to apply for a new medigap policy because there is no annual open-enrollment period.

For more information about your state’s rules, see your state insurance department website. You can find links at www.naic.org/map. Most 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.