Jeffrey Wade
Medicare beneficiaries have an annual open enrollment period of nearly eight weeks, from October 15 to December 7, during which they can make changes to their Medicare coverage. This includes joining, dropping, or switching plans for the upcoming year. People enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or traditional Medicare. Medicare beneficiaries are encouraged to review their current coverage and compare it with other options available to them. The Medicare Supplement Open Enrollment Period is a one-time, six-month window that begins the first day of the month an individual is enrolled in Medicare Part B and is 65 or older. During this period, insurance companies cannot deny coverage or charge higher premiums based on health status. However, after this period, buying a Medigap policy may be more difficult and expensive, and it is not guaranteed.
| Characteristics | Values |
|---|---|
| Medicare Supplement Insurance plan | Also known as Medigap, it helps cover the gaps in Original Medicare coverage, including out-of-pocket costs like Part A and Part B deductibles, copayments, and coinsurance. |
| Eligibility | Age 65 or older and enrolled in Medicare Parts A and B. In some states, those under 65 are eligible if they have a disability or End Stage Renal Disease. |
| Enrollment Period | The one-time enrollment period is 6 months, starting the first month an individual has Medicare Part B and is 65 or older. |
| Medicare Advantage Open Enrollment Period (MA OEP) | Jan. 1–March 31. |
| Medicare Open Enrollment Period | Each year from October 15th to December 7th. |
| Guaranteed Issue Rights | Situations where an insurance company can't deny a Medigap policy due to pre-existing conditions. |
| Special Enrollment Period (SEP) | Allows individuals to join or switch to another plan when certain life events occur. |
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What You'll Learn
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, also known as Medigap, is extra insurance provided by private insurance companies to help pay for out-of-pocket costs in Original Medicare. Medigap policies are designed to supplement the coverage provided by Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance). These policies can help reduce the financial burden of medical expenses that are not fully covered by Original Medicare.
It's important to note that Medigap is only available to individuals who have enrolled in Original Medicare. In most cases, you must have both Part A and Part B of Original Medicare before you can purchase a Medigap policy. There is a specified Medigap Open Enrollment Period, which is a one-time, six-month period that begins when an individual first enrols in Medicare Part B and is 65 or older. During this period, individuals can enrol in any Medigap policy of their choice, and insurance companies cannot deny coverage based on pre-existing health conditions. This Open Enrollment Period is distinct from the annual Medicare Open Enrollment Period, which allows individuals to make changes to their existing Medicare coverage or switch between Medicare Advantage and traditional Medicare.
After the Medigap Open Enrollment Period, purchasing a Medigap policy may become more difficult and expensive. While it is not impossible to obtain Medigap coverage outside of the Open Enrollment Period, insurance companies have more flexibility to deny coverage based on medical underwriting requirements. However, there are certain situations where individuals may have guaranteed issue rights, allowing them to purchase a Medigap policy outside of the standard enrollment period. These rights vary by state, and individuals should consult their State Insurance Department for specific information.
It is worth noting that individuals under 65 who have Medicare due to a disability or ESRD may face challenges in purchasing a Medigap policy. Federal law does not mandate insurance companies to sell Medigap policies to individuals under 65, but some states offer Medigap policies to this demographic. When individuals with disabilities turn 65 and become eligible for Medicare, they qualify for the Medigap Open Enrollment Period and can choose any Medigap policy available to them.
Medigap policies are regulated by federal and state laws, and it is important for individuals to be aware of their rights and protections when shopping for a policy. Comparing different Medigap plans and understanding how they work alongside other Medicare coverage can help individuals make informed decisions about their healthcare options.
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Guaranteed issue rights
Medicare beneficiaries have an annual open enrollment period of nearly eight weeks to make changes to their Medicare coverage. This is separate from the initial enrollment period for people newly enrolling in Medicare, which begins three months before their 65th birthday and ends three months after it.
Medicare Supplemental Insurance, or Medigap, is extra insurance you can buy from a private insurance company to help pay your share of out-of-pocket costs in Original Medicare. You can only buy Medigap if you have Original Medicare, which means you have to sign up for Medicare Part A and Part B before you can buy a Medigap policy.
During the Medigap Open Enrollment period, you can enroll in any Medigap policy, and the insurance company cannot deny you coverage due to pre-existing health problems. After this period, you may not be able to buy a Medigap policy, or it may cost more. Your Medigap Open Enrollment Period is a one-time enrollment period and does not repeat every year like the Medicare Open Enrollment Period.
There are certain situations where you may be able to buy a Medigap policy outside of your Medigap Open Enrollment Period. These situations are called "guaranteed issue rights" or "Medigap protections." Guaranteed issue rights are rights that you have in situations where insurance companies must offer you certain Medigap policies. An insurance company must sell you a Medigap policy, cover all your pre-existing health conditions, and cannot charge you more for a Medigap policy because of past or present health problems.
Some instances where you can use guaranteed issue rights include when you lose coverage for reasons beyond your control, if you use a trial right, or because you move out of your policy's coverage area. You may also qualify for guaranteed issue rights if a company misleads you or does not follow the rules for Medicare Supplement plans.
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Medicare Advantage plans
Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Special Needs Plans (SNPs), Medicare Medical Savings Accounts (MSAs), and Private Fee-for-Service Plans (PFFS).
Each year, Medicare beneficiaries have an opportunity to make changes to their Medicare coverage during the annual open enrollment period, which lasts nearly eight weeks. During this time, individuals enrolled in a Medicare Advantage plan can choose a different Medicare Advantage plan or switch to traditional Medicare.
It is important to note that Medicare Advantage Plans can disenroll individuals for various reasons, such as moving outside the plan's service area, losing Medicare or Medicaid eligibility, joining a drug plan, or if the plan's contract with Medicare ends. In such cases, individuals become eligible for a Special Enrollment Period, allowing them to review their options and ensure they have the desired Medicare health and drug coverage.
Before joining a Medicare Advantage Plan, it is recommended to consult with one's employer, union, or benefits administrator to understand the potential impact on existing coverage. Additionally, individuals should be aware of illegal practices by insurance companies and protect themselves when shopping for a Medicare Advantage Plan or any associated Medigap policy.
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Medicare Part D
To enrol in Part D, beneficiaries must also be enrolled in either Medicare Part A or Part B. They can enrol directly through the plan's sponsor or through an intermediary. The number of offered plans varies geographically, but enrollees typically have dozens of options to choose from. Enrollees often compare premiums, covered drugs, and cost-sharing policies when selecting a plan. Medicare offers an interactive online tool that allows for the comparison of coverage and costs for all plans in a geographic area. This tool lets users input their medications and calculates personalised projections of their annual costs under each plan option.
Part D plans are provided by private insurance companies that receive premiums from both enrollees and the government. These plans typically pay most of the cost for prescriptions but are reimbursed for much of this cost through rebates paid by drug manufacturers and pharmacies. Enrollees cover a portion of their own drug expenses by paying cost-sharing. The amount of cost-sharing an enrollee pays depends on the retail cost of the filled drug, the rules of their plan, and whether they are eligible for additional Federal income-based subsidies. The average monthly Part D premium across all plans was $27 in 2020, but premiums have decreased since 2017 despite rising per capita drug spending.
In 2019, about three-quarters of Medicare enrollees obtained drug coverage through Part D, with 47 million beneficiaries enrolled. Part D accounted for 12% of Medicare spending that year, with program expenditures totalling $102 billion.
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State Insurance Departments
The State Insurance Department is the go-to resource for understanding your rights under state law. Each state may have unique provisions that impact your ability to purchase a Medigap policy outside of the standard enrollment period. For instance, some states offer additional Open Enrollment periods for individuals under 65 who are eligible for Medicare due to a disability or End Stage Renal Disease (ESRD). Thus, checking with your State Insurance Department is essential to know your options and rights.
State laws also protect individuals from illegal practices by insurance companies. Medigap policies are subject to both federal and state laws designed to safeguard applicants. State Insurance Departments can provide clarity on these laws and help individuals navigate the process of purchasing supplemental Medicare insurance. They can guide individuals on comparing plans, understanding coverage, and avoiding potential pitfalls or illegal practices.
In addition to state-specific rights, State Insurance Departments can inform individuals about their guaranteed issue rights, also known as Medigap protections. These rights ensure that insurance companies cannot deny individuals a Medigap policy under certain circumstances. For example, if you lose other health coverage or move out of your Medicare Advantage plan's service area, you may qualify for a guaranteed issue right, allowing you to purchase a Medigap policy outside of the standard enrollment period.
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Frequently asked questions
The Medigap Open Enrollment Period is a one-time, 6-month period that starts the first month you have Medicare Part B and are 65 or older. During this time, you can enrol in any Medigap policy and insurance companies cannot deny you coverage based on pre-existing health conditions.
If you miss the Open Enrollment Period, you may not be able to buy a Medigap policy, or it may cost more. You may still be able to buy a policy outside of this period if you qualify for a guaranteed issue right, for example, if you lose other health coverage or move out of your plan's service area.
To find out if you qualify for a guaranteed issue right, check with your State Insurance Department to see what rights you have under state law.
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