Exploring Options: Navigating The Path To Changing Your Medigap Insurer

You can change your Medigap insurer at any time, but there are some important things to consider. If you switch outside of your Medigap Open Enrollment Period, you may have to go through medical underwriting and could face higher prices or even denial of coverage. This is because insurers can refuse to sell you a policy, delay coverage, or charge you a higher premium due to a pre-existing health condition. However, there are certain situations in which you have the guaranteed-issue right to buy a policy outside of your Open Enrollment Period, such as if your Medigap insurer goes bankrupt or if you move out of your plan's service area.

Changing Medigap insurer during the Open Enrollment Period

You can change your Medigap insurer during the Medigap Open Enrollment Period, which is a six-month period that starts when you are 65 or older and enrolled in Medicare Part B. During this period, insurance companies cannot deny you coverage or charge you more based on your health or pre-existing conditions. This is because you have guaranteed issue rights during this time.

If you miss the Open Enrollment Period, you may still be able to change your Medigap insurer, but you will likely have to go through medical underwriting, and you may face higher prices or even be denied coverage. There are some exceptions, however. You may have guaranteed issue rights if you are in one of the following situations:

• Your Medigap insurer has gone bankrupt or ended your policy through no fault of your own.
• You leave your Medigap insurer because they misled you or did not follow the rules.
• You have a Medicare Advantage plan that is leaving your service area or discontinuing coverage in your area.
• You have Original Medicare, and your employer coverage is ending.
• You have Original Medicare and a Medicare SELECT plan, and you move out of the plan's service area.
• You dropped a Medigap policy to join a Medicare Advantage plan, but within the first year, you want to switch back to Medigap.

It is important to note that the rules for changing Medigap plans vary by state, so it is recommended to consult with a licensed insurance agent or check your state's insurance website for specific information.

Changing Medigap insurer outside of the Open Enrollment Period

Eligibility and Timing

Changing Medigap insurers outside of the Open Enrollment Period is generally allowed, but it may be difficult to find a new insurer without undergoing medical underwriting. This process involves assessing your health, age, and other factors, which could result in higher premiums or even denial of coverage. Therefore, it is recommended to change Medigap insurers during the Open Enrollment Period when you have guaranteed issue rights and protection from higher rates.

Specific Circumstances

In certain specific circumstances, you may qualify for guaranteed issue rights, allowing you to change Medigap insurers outside of the Open Enrollment Period. These circumstances include situations such as:

• Moving outside of your current Medigap plan's service area
• Losing your existing Medigap coverage due to reasons beyond your control, such as the insurer going bankrupt or failing to follow rules
• Switching from a Medicare Advantage plan to Medigap within the first year of enrolling in Medicare Advantage
• Experiencing issues with your current Medigap insurer, such as misleading information or failure to comply with regulations

State-Specific Variations

It is important to note that regulations regarding Medigap insurer changes vary by state. Some states, like California, allow more flexibility in changing Medigap plans annually due to expanded regulations. In contrast, other states may have more limited options for changing Medigap insurers outside of the Open Enrollment Period. Therefore, it is essential to check the rules specific to your state of residence.

Application Process

When applying for a new Medigap plan outside of the Open Enrollment Period, you will need to specify the circumstances that qualify you for guaranteed issue rights. Documentation may be required to prove your eligibility and the timing of your eligibility. Remember to apply within 63 days of your previous coverage ending to ensure a smooth transition.

Alternative Options

If changing Medigap insurers proves challenging, you may consider other options, such as comparing rates and benefits between different insurers to find a better deal or waiting until the next Open Enrollment Period to make changes. Additionally, consulting a licensed insurance agent can provide you with personalised advice and guidance on navigating the process.

Changing Medigap insurer with pre-existing conditions

The Medigap Open Enrollment Period is a six-month period that begins when you are 65 or older and enrolled in Medicare Part B. During this time, insurance companies cannot deny you coverage or charge you higher premiums because of a pre-existing health condition. This is because, during this period, you have something called "guaranteed issue rights".

If you are past your Medigap Open Enrollment Period, you may still be able to change your Medigap insurer or plan without medical underwriting if you have a guaranteed issue right. A guaranteed issue right is a specific set of circumstances that allow you to change policies without underwriting, coverage delay, or denial. These circumstances include:

• Your Medigap insurance company going bankrupt or ending your policy with no fault of your own.
• Your Medigap insurance company committed fraud and you are cancelling your policy.
• You leave your current Medigap insurer because the company misled you.
• You have a Medicare SELECT plan and move out of the service area.
• You've been enrolled in a Medigap insurance plan for fewer than six months and your insurance company may agree to sell you a new policy with the same basic benefits, but there may be a wait of up to six months before the new plan covers pre-existing health conditions.
• You signed up for a Medicare Advantage plan for the first time but then choose to cancel that policy and return to Original Medicare with a Medigap plan instead.

It is important to note that the above list is not exhaustive and there may be other situations that qualify you for a guaranteed issue right. Additionally, the specific circumstances that qualify you for a guaranteed issue right may vary depending on your state. For example, in California, you can change Medigap plans annually due to the state's expanded regulations. Therefore, it is important to check your local rules.

If you don't have guaranteed issue rights and want to switch your Medigap insurer or plan, your application may include medical underwriting and your new plan could have higher premiums than your current plan. The insurance carrier who sells the new plan you want could also deny you coverage.

If you are thinking of changing your Medigap insurer, it is recommended that you consult with a licensed insurance agent to discuss your options.

Changing Medigap insurer without underwriting

While it is possible to change your Medigap insurer at any time, there are important things to know about when you can switch and what some consequences may be. For instance, if you switch outside of your Medigap Open Enrollment Period, you may have to go through medical underwriting unless you qualify for a guaranteed issue right.

Guaranteed issue rights

In certain situations, you can change Medigap plans or purchase a new Medigap plan without being subject to medical underwriting. These situations are called guaranteed issue rights.

You may qualify for a Medigap guaranteed issue right at any time of the year if you fit one of the following descriptions:

• You currently have a Medicare Advantage plan that is leaving Medicare or ending coverage in your area.
• You have a Medicare Advantage plan, and you are moving out of the plan's service area.
• You have Medicare Part A and Part B (Original Medicare), and you need to replace an employer health plan that will soon be discontinued.
• You have Original Medicare and a Medicare SELECT policy, and you move out of the policy's service area.
• You joined a Medicare Advantage plan or a Program of All-Inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining you want to switch to Original Medicare.
• You dropped a Medigap policy to join a Medicare Advantage plan for the first time, and within the first year of joining you want to switch back to Medigap.
• Your Medigap insurance company goes bankrupt or ends your policy through no fault of your own.
• You leave a Medicare Advantage plan or Medigap policy because the company misled you or did not follow federal Medicare rules.

State-specific rules

Some states have laws that allow you to change Medicare supplement plans without underwriting. These include:

• California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon, which have the Medigap Birthday Rule. If you are currently enrolled in a Medigap plan, you can change to a different Medigap plan each year around your birth month with no medical questions asked.
• Connecticut and New York, which have guaranteed issuance for all at any time.
• Missouri, which has the Medigap Anniversary Rule. This allows you to switch 30 days before and 30 days after the anniversary date of when you first signed up.
• Massachusetts, which has an annual Medigap open enrollment for Mass switching period from February 1 to March 31.
• Maine, which allows enrollees to switch to a Medigap plan that has the same or fewer benefits, at any time of the year.
• Washington, which allows enrollees to switch from any Washington Medigap to any other Medigap except Plan A at any time of the year.

Other considerations

If you switch Medigap plans, don't cancel your original Medigap plan until you've decided to keep your new plan. You'll have to pay the premiums for both plans for one month, but if you want to change back to your original Medigap plan, you will still be able to do so.

Changing Medigap insurer when moving

If you have Original Medicare and a Medigap plan, your insurer must let you keep your coverage when you move. However, your monthly payment may change as states determine Medigap premiums differently. If you want to switch to a different Medigap policy when you move from state to state, you'll need to check with your current or new insurance company to see if they will offer you a different policy and when you should apply. If you decide to switch, you may have to pay more for your new Medigap policy or answer some medical questions when you apply for your new plan.

You can keep your current Medicare supplement if you are moving within the US, but if you are moving to Massachusetts, Minnesota, or Wisconsin, you will have to apply for a new Medigap plan as these states have their own Medigap plans.

If you are moving outside the US, you can keep your Medicare plan active, but you won't be able to use your benefits in a foreign country.

If you are moving outside of your current Medigap plan's service area, you will need to switch to a new plan.

In most states, you can change your Medigap plan at any time, but you may face higher prices or denial of coverage. However, there are certain situations in which you have the guaranteed-issue right to buy a Medigap policy outside of your Medigap Open Enrollment Period. These include:

• Moving out of your Medicare Advantage plan's service area
• Your Medicare Advantage plan has been discontinued or is leaving Medicare
• You have Original Medicare and your employer coverage is ending
• You have Original Medicare and a Medicare SELECT policy, and you move out of the policy's service area
• Your Medigap insurance company goes bankrupt or ends your policy through no fault of your own
• You leave your current Medigap insurer because the company misled you or did not follow federal Medicare rules

If you are moving, it is important to contact Social Security or the Railroad Retirement Board to update the mailing address that Medicare has on file.

Frequently asked questions