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It’s important to understand when to enroll in a Medigap plan. There can be significant consequences for failing to enroll in a Medigap plan at the correct time. When you first become eligible for Medicare and during certain special circumstances, you can enroll in a Medigap plan without having to health qualify. If you apply for a Medigap plan outside those enrollment periods, you may be denied coverage or have to pay more for your plan.
What is a Medigap plan?
A Medicare Supplement plan, also known as a Medigap plan, is a health insurance policy designed to supplement the coverage provided by Original Medicare. You must be enrolled in Medicare Part A and Part B to be eligible to join a Medigap plan.
These plans help cover some of the costs not covered by Original Medicare, such as:
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copayments
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coinsurance, and
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deductibles
Medigap plans are offered by private insurance companies and must be approved by the Centers for Medicare & Medicaid Services (CMS).
Medigap vs. Medicare Advantage
Medigap and Medicare Advantage (sometimes called Part C) plans cover medical expenses not covered by Original Medicare. The main difference between the two is how the coverage works. A Medigap plan supplements Original Medicare, covering copayments, coinsurance, and deductibles. Medicare remains primary. Medigap plans offer no coverage for prescriptions. The member would need to select a Part D plan in addition to their Medigap plan to add drug coverage.
A Medicare Advantage plan replaces Original Medicare Part A and Part B, offering an all-in-one bundle of benefits that often include prescription drug coverage. With a Medicare Advantage plan, you may also get extra benefits like vision, dental and hearing coverage.
To learn more about Medicare Advantage plans, click here.
It’s important to understand when to enroll in a Medigap plan. There can be significant consequences for failing to enroll in a Medigap plan at the correct time.
Understand Your Rights
Guarantee Issue Rights (GIR) allow you to purchase any Medigap plan available in your area regardless of your medical condition. If you have GIR, the insurance company cannot ask you questions about your health.
Let’s look at some instances where you may have GIR to select a Medigap plan.
Open Enrollment Period
The Medigap Open Enrollment Period (OEP) is a six-month window that starts when you are 65 years or older and first enroll in Medicare Part B. During this time, you have Guarantee Issue Rights to buy any Medigap plan available in your area, regardless of your medical history. In other words, insurance companies can’t deny coverage due to pre-existing conditions during someone’s OEP. However, after the OEP ends, insurers may have the right to reject applicants or charge more for a policy for people with specific health issues. Your OEP can’t be changed or repeated.
Federal law doesn’t extend Guarantee Issue Rights to people under 65 on Medicare. If this is your situation, we recommend you check your state’s guidelines.
Special Enrollment Periods
Special Enrollment Periods (SEPs) for Medigap policies occur during certain events. These include:
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Moving out of the coverage area of your current plan
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Losing other health insurance coverage, or
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Being dropped from existing coverage due to a change in employer size or status.
You can buy any Medigap plan available in your area with Guaranteed Issue Rights if you qualify for a Special Enrollment Period. SEPs typically last for two months following the qualifying event. Be sure to check with Medicare to understand your SEP’s timeframe.
To view more examples of SEPs, click here.
What About AEP?
Medicare’s Annual Election Period (AEP) goes from October 15th through December 7th of each year. This enrollment period does not apply to Medigap plans.
AEP is an enrollment period that allows you to change a Medicare Advantage (Part C) or a prescription drug (Part D) plan. If you have a Medigap plan, you may use AEP to change your Part D coverage, or you can drop your Medigap plan and enroll in a Medicare Advantage plan. If you’re happy with your Medigap plan, there’s nothing you need to do during AEP.
Choosing a Plan
Medigap plans help cover some of the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. Knowing when to enroll in a plan is important so you can select the coverage you need. Enrolling during your OEP or a SEP means you don’t have to health qualify and can’t be charged more for your Medigap plan.
To discuss your situation and learn about the plans offered in your area, call us at (800) 398-8714. An experienced licensed insurance agent will give you a breakdown of your options. There is no cost to work with an agent and never an obligation to enroll in a plan. We are here to answer your questions and navigate the complicated process of selecting a Medicare health plan.
Although we strive to be as accurate as possible, any differences between this document and the information on Medicare.gov will be governed by the information on Medicare.gov.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
