Medigap Enrollment Periods

June 24, 20243 min read

Medigap Enrollment Periods

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 copayments, coinsurance, and 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 includes prescription drug coverage. With a Medicare Advantage plan, you may also get extra benefits like vision, dental and hearing coverage.

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) are a requirement that you may purchase any Medigap plan available in your area regardless of your medical condition. Let's look at some instances where you may have GIR to select a Medigap plan.

Initial Enrollment Period

The Medigap Initial Enrollment Period (IEP) 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 IEP. However, after the IEP ends, insurers may have the right to reject applicants or charge more for a policy for people with specific health issues. Your IEP 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:

Moving out of the coverage area of your current plan

Losing other health insurance coverage, or

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.

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 IEP or a SEP means you don't have to health qualify, and you aren't charged more for your Medigap plan.

To discuss your situation and learn about the plans offered in your area, call us at (925) 684-6701. 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.

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