Medigan Insurance: Change Deadline Looms

Medicare Advantage enrollees can change their 2023 coverage during the Medicare Advantage open enrollment period, which runs from January 1 to March 31. During this time, enrollees are allowed to make one plan change, either switching to a different Medicare Advantage plan or moving to Original Medicare. It is important to note that the Medicare Open Enrollment Period, which occurs from October 15 to December 7 each year, is only for switching between Medicare Advantage or Part D drug plans.

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period is an annual period during which members of a Medicare Advantage plan can make changes to their existing plan or disenroll from their current plan and return to Original Medicare. This period runs from January 1 to March 31.

During the Medicare Advantage Open Enrollment Period, you can make the following changes:

• Switch to another Medicare Advantage plan, with or without drug coverage
• Switch back to Original Medicare, and if needed, add a Medicare Part D plan

It is important to note that you can only make one change within this period, and other rules apply. The changes you can make during the Medicare Advantage Open Enrollment Period are similar to those during the Medicare Annual Enrollment Period (October 15 - December 7). However, the main difference is that the Annual Enrollment Period is for anyone who has Medicare, while the Advantage Open Enrollment Period is only for people enrolled in a Medicare Advantage plan.

The Medicare Advantage Open Enrollment Period provides an opportunity to confirm or change your plan choice. It is recommended to review your plan benefits and consider your experiences using the plan, including:

• Whether your doctor and other providers are in the plan's network
• Whether your prescription drugs are on the plan's formulary
• Whether you are comfortable with the costs, including premiums, deductibles, copays, and coinsurance
• Whether you have the additional coverage you want, such as dental, vision, and hearing care
• Whether you are happy with the plan's additional benefits, such as fitness programs, mail-order pharmacy, and nurse line

If you decide to make a change during the Medicare Advantage Open Enrollment Period, it will take effect on the first of the following month after the receipt of your enrollment request.

Switching from Medicare Advantage to Medigap

Step 1: Determine Eligibility

If you are enrolled in a Medicare Advantage plan and are unhappy with your coverage, you can switch to a Medigap plan during specific enrollment periods. These include the Annual Enrollment Period from October 15 to December 7 and the Medicare Advantage Open Enrollment Period from January 1 to March 31. Additionally, you may qualify for a Special Enrollment Period, such as moving outside your plan's service area, which grants guaranteed issue rights.

Step 2: Research Medigap Plans and Carriers

Medigap plans are standardized, but it is important to research the available plans and carriers in your area to determine which plan best fits your needs. Carriers determine your monthly premium, so finding a low-cost plan with great customer service is essential.

Step 3: Apply for Medigap Coverage

Before leaving your Medicare Advantage plan, apply for coverage through the Medigap carrier you wish to enroll with. It is crucial to ensure you are approved for Medigap coverage before cancelling your current plan to avoid being stranded without insurance.

Step 4: Disenroll from Your Medicare Advantage Plan

Once you are approved for Medigap coverage, you must drop your Medicare Advantage plan. Remember, you can only have active coverage from either a Medigap plan or a Medicare Advantage plan at one time.

Important Considerations:

• Medical Underwriting: When switching to a Medigap plan, you may need to undergo medical underwriting and answer health questions. This process allows the insurer to assess your health, age, and other factors to determine your coverage eligibility and premiums.
• Timing: It is essential to carefully time your switch to ensure continuous coverage. Your enrollment period typically lasts for about four months, starting 60 days before and ending 63 days after your other coverage ends.
• Costs: Medigap plans generally have higher premiums than Medicare Advantage plans but offer more comprehensive coverage. Consider your specific needs and compare the costs of premiums, copayments, and out-of-pocket expenses to make an informed decision.

Guaranteed issue rights

There are two situations in which you won't be subjected to medical underwriting when applying for a Medicare Supplement Insurance plan:

• During your Medicare Supplement Open Enrollment Period (OEP), which lasts for six months and starts when you are both 65 or older and enrolled in Medicare Part B.
• If you have guaranteed-issue rights.

• You have another form of health coverage that is changing or that you are going to lose within a short period of time.
• You have a Medicare Advantage (Part C) plan that is leaving Medicare or is ending its coverage in your area, or you are moving out of your plan's service area.
• You are covered by Original Medicare Parts A and B as well as a group health plan provided by your employer or union that is ending.
• You are covered by Original Medicare Parts A and B and Medicare SELECT but are leaving your coverage area for Medicare SELECT.
• You have a Medicare Advantage (Part C) plan but are switching back to Original Medicare.
• You initially had a supplement plan but now have a Medicare Advantage plan (and have had it for less than a year), and you wish to change back to a Medicare Supplement plan.
• Your private insurance provider goes bankrupt or your policy ends in a way that is not your fault.
• Your private insurance provider has been misleading or fraudulent, and you decide to cancel your plan because of this.

In some cases, if you are in your "trial right" period for a Medicare Advantage (Part C) plan, which is up to 12 months after initial enrollment, you also have guaranteed issue rights to purchase a private supplemental health insurance plan during this special enrollment period. Federal law allows 63 days of guaranteed issue rights after you disenroll from your Medicare Advantage plan, giving you time to enroll in a Medicare supplement plan.

It is important to note that guaranteed issue rights may vary by state, so it is recommended to check with your State Health Insurance Assistance Program to ensure that you qualify for guaranteed issue rights.

Special Enrollment Period

A Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.

Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the event to enroll in a plan. You can enroll in Medicaid or the Children's Health Insurance Program (CHIP) at any time.

• Losing health coverage: You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days.
• Changes in residence: You may qualify for a Special Enrollment Period if you move to a new home in a new ZIP code or county, or to the U.S. from a foreign country or U.S. territory.
• Changes in household: You may qualify for a Special Enrollment Period if, in the past 60 days, you or anyone in your household got married, had a baby, got divorced, or experienced the death of a family member.
• Loss of health coverage: You may qualify for a Special Enrollment Period if you lose health coverage through your employer or if your individual health coverage is discontinued.
• Eligibility for Medicare: You may qualify for a Special Enrollment Period if you lose premium-free Medicare Part A.
• An employer offer to help with the cost of coverage: You may qualify for a Special Enrollment Period if you or anyone in your household is offered an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).

In addition to the life events mentioned above, other situations that may qualify you for a Special Enrollment Period include gaining membership in a federally recognized tribe, becoming a U.S. citizen, leaving incarceration, or starting or ending service as an AmeriCorps member.

It's important to note that you may be required to submit documents confirming your eligibility for a Special Enrollment Period. These documents should be submitted within 30 days of picking a plan. Your coverage will start on the first day of the month after you select a plan.

Annual Open Enrollment

The Medicare Advantage Open Enrollment Period takes place from January 1st to March 31st. During this time, Medicare Advantage enrollees can make one plan change, either switching to a different Medicare Advantage plan or to Original Medicare.

The Medicare Annual Election Period (AEP) takes place between October 15th and December 7th. This is when you can seamlessly switch from one Medicare Advantage or Medicare Part D plan to another.

Medigap Open Enrollment is a one-time Initial Enrollment Period that takes place when an individual is over 65 and enrolled in Medicare Part B. During this time, you have six months to enroll in any Medigap plan, regardless of your health. If you decide you don't like the plan during this period, you can switch to a different Medigap policy within 30 days.

In some states, there are additional opportunities to switch Medigap plans. For example, California allows individuals to change Medigap plans annually due to expanded regulations. Connecticut and New York also offer guaranteed issuance for all at any time.

Frequently asked questions