Medicare Supplement annual enrollment period timing?
Navigating Medigap: Understanding Your Guaranteed Issue Rights
Medigap, a supplemental health insurance offered by private insurance companies, can help cover the costs that Original Medicare (Parts A and B) doesn't. Here's a guide to understanding your guaranteed issue rights, a protection that ensures you can access Medigap coverage without health discrimination or premium surcharges related to your medical history.
Initial Medigap Open Enrollment Period (OEP)
This 6-month window begins the month you turn 65 and enroll in Medicare Part B. During this period, you can buy any Medigap plan available in your state without medical underwriting or rejection due to health conditions.
Guaranteed Issue Periods Outside Initial OEP
These situations occur when you lose other health coverage, such as employer plans, Medicaid, Medicare Advantage plans, or when your Medicare Advantage plan leaves your area or stops coverage. When these events happen, you usually have up to 63 days to enroll in a Medigap plan with guaranteed issue rights.
Trial Rights
Trial rights apply in two situations:
- If you join a Medicare Advantage plan when you first become eligible for Medicare at age 65, then within 12 months decide to switch back to Original Medicare and buy a Medigap plan. During this 12-month trial period, you have guaranteed issue rights to buy Medigap without health questions or exclusions.
- If you leave a Medigap policy to join a Medicare Advantage plan for the first time, but then want to return to Medigap within the first year, you have trial right protections if the original Medigap policy is still available.
Some states provide additional or extended guaranteed issue rights, such as the "Medigap Birthday Rule," which allows residents to switch Medigap plans annually without underwriting, regardless of health status.
Key Points Summary
- Initial Medigap Open Enrollment: 6 months after Part B starts; guaranteed issue rights apply for any Medigap plan.
- Guaranteed Issue Situations: Loss of coverage, plan leaving area, insurer bankruptcy, misleading sales, moving out of plan service area (usually 63 days to enroll).
- Trial Rights: 12-month right to switch from Medicare Advantage to Medigap after initial enrollment, or return to Medigap within a year of switching to Medicare Advantage.
- State Variations: Some states extend guaranteed issue rights or add rules like the Medigap Birthday Rule.
- Underwriting: Outside these periods or conditions, medical underwriting typically applies.
These protections ensure that beneficiaries can access Medigap coverage when changing circumstances without health discrimination or premium surcharges related to medical history.
Remember, you can compare Medigap plans offered in your state using the Medigap plan finder tool. However, each Medigap plan covers one person; if a person and their spouse both want a Medigap policy, each must buy their own. Also, if a company decides to increase the cost of a plan based on an individual's past or present health problems, it is entitled to do so outside of the Medigap Open Enrollment Period (OEP) only.
For more information, visit the official Medicare website or consult with a healthcare professional.
[1] Medicare.gov [2] Healthcare.gov [3] State Health Insurance Assistance Program (SHIP) [4] Medicare Rights Center [5] AARP
Health-and-wellness organizations should emphasize that understanding Medicare's guaranteed issue periods is crucial for senior citizens, as it allows them to access Medigap coverage without discrimination or premium surcharges based on medical history. Additionally, science-driven research in the field of health insurance might help in devising more inclusive policies for people transitioning through various healthcare plans, ensuring the availability of affordable health insurance coverage for all, such as Medigap and Medicare.
