Orlando Harmon
Medicare Supplement Insurance plans, or Medigap, are private insurance products that can be purchased in addition to Original Medicare (Parts A and B) to help reduce your share of costs. While there is no specific time of year designated for switching plans, there are certain circumstances that allow you to switch without penalty. For example, you can switch during your 6-month Medigap Open Enrollment Period or if you are moving out of the policy's service area. You may also be able to switch if you are within a guaranteed issue right, which is when an insurance company cannot deny you a policy.
| Characteristics | Values |
|---|---|
| When can you switch? | During your 6-month Medigap Open Enrollment Period |
| If you're eligible under a specific situation or guaranteed issue right | |
| If you're moving or facing other special circumstances | |
| During the yearly Medicare Open Enrollment Period (between October 15 – December 7 each year) | |
| No more than 63 days after your Medicare Advantage Plan coverage ends | |
| Within 12 months of switching to Medicare Advantage | |
| 60 days before your Medicare SELECT coverage ends | |
| If you've had your current Medigap policy for less than 6 months | |
| If you've had your Medicare SELECT policy for more than 6 months | |
| What to do before switching? | Keep letters, notices, emails or claim denials as proof of your coverage being terminated |
| Make sure to apply no more than 63 days after your coverage ends | |
| Contact your State Insurance Department to understand your rights under state law | |
| Contact the Medigap insurance company for more information | |
| Don't cancel your first Medigap policy until you've decided to keep your second Medigap policy |
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What You'll Learn
Switching from Medigap to Medicare Advantage
Understanding the Difference
Medigap, or Medicare Supplement Insurance, is a supplemental policy to Original Medicare (Part A and Part B) that helps cover out-of-pocket expenses, such as copayments, coinsurance, and deductibles. On the other hand, Medicare Advantage (Part C) is an alternative way to receive Original Medicare benefits through a private insurance company. It covers everything that Original Medicare covers and may offer additional benefits, such as routine vision, dental, and hearing care. It is important to note that you cannot have both Medigap and Medicare Advantage simultaneously.
To switch from Medigap to Medicare Advantage, follow these steps:
- Drop your Medigap policy: Contact your Medigap insurance company to cancel your current policy. Keep in mind that once you cancel your Medigap policy, you might not be able to get it back.
- Enroll in Medicare Advantage: You can generally only join a Medicare Advantage Plan during the Medicare Open Enrollment Period, which runs from October 15 to December 7 each year. If you enroll during this period, your Medicare Advantage coverage will begin on January 1 of the following year.
- Consider prescription drug coverage: If you want prescription drug coverage, you will need to sign up for a separate Medicare drug plan (Part D) or choose a Medicare Advantage plan that includes this coverage.
Switching Back to Medigap from Medicare Advantage
If you decide to switch back to Medigap from Medicare Advantage, you can do so, but there are specific requirements and considerations:
- Disenroll from Medicare Advantage: Contact your insurance company or Medicare directly to request disenrollment from your Medicare Advantage plan.
- Return to Original Medicare: Before enrolling in Medigap, you will need to switch back to Original Medicare, Part A and Part B.
- Apply for Medigap: Once you have left your Medicare Advantage plan and enrolled in Original Medicare, you are generally eligible to apply for a Medigap policy. However, you may lose your "guaranteed-issue" rights for Medigap, which protect against denial of coverage or higher premiums due to pre-existing conditions.
- Timing considerations: In most cases, you can only leave a Medicare Advantage plan during specific periods, such as the Medicare Advantage Open Enrollment Period (January 1 to March 31) or the Annual Election Period (October 15 to December 7). Outside of these periods, you may switch if you meet certain requirements, such as moving outside your plan's service area.
- Medigap plan options: When choosing a Medigap policy, you can switch to a different plan offered by your current insurance company or select a new plan from another company. Ensure that you apply within the specified time frames, such as 60 to 63 days after your previous coverage ends.
- Pre-existing conditions: If you switch to a new Medigap policy, there may be a waiting period before your new benefits cover pre-existing conditions.
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Switching during the Medigap Open Enrollment Period
The first time you can sign up for a Medigap plan is during your six-month Medigap Open Enrollment Period, which begins the first month that you have Medicare Part B coverage and are 65 or older. This initial enrollment period is the most cost-effective time to buy a Medigap plan, as it will generally give you the lowest price and the most plan choices.
During this six-month period, you can switch between Medigap policies without penalty. If you buy a Medigap policy during this period and decide you don’t like the policy, you can switch to a different Medigap policy. However, you will need to pay both premiums for the month that you have both policies, and you should not cancel your first policy until you have decided to keep your second policy.
After the initial Medigap Open Enrollment Period, your options to switch plans are more limited, and if you are able to buy a new plan, it may cost you more.
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Switching due to guaranteed issue rights
In most cases, federal law does not give you the right to switch Medigap policies. However, you can switch if you are within your 6-month Medigap Open Enrollment Period or if you are eligible under a specific situation or guaranteed issue right. Guaranteed issue rights refer to situations where an insurance company cannot deny you a Medigap policy, also known as "Medigap protections".
There are several situations in which guaranteed issue rights are triggered. One example is if you enroll in a Medicare Advantage plan when you turn 65, in which case you have the right to change your mind for 12 months. If you decide to leave the Medicare Advantage plan and return to Original Medicare, you can purchase a Medicare supplement, and the insurance company cannot turn you down. Similarly, if you have Original Medicare and a Medigap plan, and then switch to a Medicare Advantage plan for the first time, you have a 12-month trial right to change your mind. You can then leave the Advantage plan and re-enroll in your previous Medigap plan with the same insurance carrier.
Another situation in which guaranteed issue rights are triggered is if you move out of the plan's service area. Since Medicare Advantage plans are specific to your residential area, you will lose that plan and will be given a guaranteed-issue right to purchase a Medicare supplement in your new area. The same rule applies if you have a Medicare SELECT policy and you move outside the network.
Loss of an employer-sponsored retiree plan or second-paying union coverage could also qualify as a Guaranteed Issue right to enroll in a Medigap plan without underwriting. In some states, people who lose Medicaid due to a change in their financial situation have a guaranteed issue right to buy a Medicare supplement policy without underwriting.
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Switching Medigap policies after 6 months
First, it's important to understand your rights under federal law and state regulations. While federal law provides some protections, each state may have its own rules and opportunities for changing Medigap policies. Contact your State Insurance Department to understand your specific rights and options. Keep in mind that, in most cases, you won't be able to switch your Medigap policy outside of the 6-month Medigap Open Enrollment Period, except in certain situations when you have a guaranteed issue right.
If you're considering switching Medigap policies after 6 months, there are a few scenarios to consider:
- Changing Coverage or Insurance Companies: If you want to change your coverage or insurance company, you may be able to switch to a different Medigap policy. However, you may need to wait up to 6 months for the new policy to cover any pre-existing conditions. Keep in mind that you might have to answer medical questions during the application process, and your application could be turned down or charged more due to pre-existing conditions.
- Moving Out-of-State: If you're moving out of the policy's service area, you may need to switch to a different Medigap policy offered in your new state. Contact the insurance company in your new state to understand their specific rules and options.
- Special Circumstances: In certain situations, such as issues with your current Medigap insurance company or changes in your health needs, you may have a guaranteed issue right to switch policies. These situations vary by state, so consult your State Insurance Department for specific guidance.
- State-Specific Rules: Some states have rules that make switching Medigap policies easier. For example, California, Idaho, Illinois, Nevada, Kentucky, Louisiana, Maryland, Oklahoma, Oregon, Utah, Virginia, and Wyoming have the Medigap Birthday Rule, which allows enrollees to change to a different Medigap plan each year around their birth month without answering medical questions. Connecticut and New York also offer guaranteed issuance for all at any time. Missouri has the Medigap Anniversary Rule, which allows switching within a specific window around the anniversary of enrolling.
When switching Medigap policies, remember to keep copies of all relevant documents, including letters, notices, emails, and claim denials. You may need to provide proof of your previous coverage and termination when applying for a new Medigap policy. Additionally, be mindful of timing constraints, as you typically must apply for a new Medigap policy within 63 days of your previous coverage ending.
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Switching to a different Medigap plan
The most cost-effective time to buy or switch your Medigap plan is during the Medigap Open Enrollment period. This period begins in the first month that you have Medicare Part B coverage and are 65 or older. Purchasing or switching plans during this enrollment period will generally offer the lowest prices and the most plan choices. If you switch plans outside of this period, private insurance companies may charge higher prices or even deny coverage.
In most cases, you won't have the right to switch Medigap policies outside of the Medigap Open Enrollment Period, except under specific situations or guaranteed issue rights. These situations include instances where your insurance company misled you, broke the rules, or went bankrupt. If you are within your 6-month Medigap Open Enrollment Period, you can switch to a different Medigap policy and have 30 days to decide if you want to keep it (known as a 30-day free look period). During this period, you will need to pay premiums for both your old and new policies.
If you decide to switch Medigap plans, you must apply for the new Medigap policy within 63 days of your previous coverage ending. Keep in mind that you may need to provide documentation from your previous coverage to prove your right to buy a new policy. Additionally, if you've had your current Medigap policy for less than 6 months and switch to a new policy, you may have to wait for the new policy to cover your pre-existing conditions.
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Frequently asked questions
You can switch to a different Medigap policy during your 6-month Medigap Open Enrollment Period. If you miss this window, you may be able to switch in certain situations, such as when you have a guaranteed issue right.
A guaranteed issue right is when an insurance company cannot deny you a Medigap policy. This can occur in specific situations, such as when your insurance company goes bankrupt or misleads you.
If you have Original Medicare with a Medigap plan and want to switch to a Medicare Advantage plan, you will have to drop your Medigap plan. If you change your mind, the federal government guarantees you a 12-month period to switch back to Original Medicare with a Medigap plan.
You can switch to a Medigap Plan that is sold by an insurance company in your new state. You must apply for a new Medigap policy no more than 63 days after your previous coverage ends.
