Also known as Medigap, Medicare Supplement Insurance helps cover out-of-pocket costs for Original Medicare.
Although Medicare provides pretty good coverage and benefits, it does have some out-of-pocket costs, like your 20% co-insurance for most Part B services. It also does NOT have a maximum out-of-pocket, which means there’s no limit to what you could end up owing if you have a lengthy hospital stay or serious illness.
That’s where Medigap comes in. These plans “supplement” your Original Medicare coverage by helping pay some of your out-of-pocket costs for things like doctor visits, hospital stays, and durable medical equipment. However, Medigap plans don’t cover items not included with Parts A and B, like prescription medications. For that, you need either a Medicare Advantage plan or standalone Part D plan.
Why you might want to change Medigap plans
There are a few reasons it might be time to change Medicare Supplement Insurance. The two biggest are cost and coverage. You want to make sure you have the coverage you want, without paying for benefits you don't need. Even if costs are manageable, it's always a good idea to see if cheaper plans are available and make sure your coverage level is appropriate.
Wanting or needing to switch insurance companies is also a good reason to look for a new Medigap policy. Remember that Supplement plans are standardized, which means that all plans offer the same coverage (i.e., all plan A, B, etc. options have the same benefits regardless of the insurer you choose). The only difference is in what you pay.
Why you might not be able to switch to a new Medicare Supplement plan
The main reason you might not be able to change Medigap plans is medical underwriting. Unless you have a guaranteed issue right, there are no Federal protections that guarantee coverage.
What is medical underwriting?
Essentially, medical underwriting is a risk assessment insurance companies take. The point is to see how likely you are to file a claim based on a survey of your medical history. Questions typically relate to age, any chronic conditions, drug history (both prescription and recreational), weight and more. Some insurers delve more extensively into medical history, and may also include mental health history.
There are some conditions that may lead to your application being rejected, including (but not limited to):
- Cancer or history of cancer
- Kidney failure
You may also be denied if you use any of the following:
- Implantable cardiac defibrillator
- Medications for COPD or multiple sclerosis
- Supplemental oxygen
You can avoid medical underwriting if you apply for Medicare Supplement Insurance during your Medigap Open Enrollment Period (OEP). This starts the first month you are both 65 and enrolled in Medicare Part B. If for no other reason than this, it is best to purchase a plan during your OEP, even if you don't think you need it yet. Medical underwriting can also be bypassed if you have a guaranteed issue right.
Learn more: Medicare Supplement Underwriting Questions: What to Expect
What are guaranteed issue rights?
Guaranteed issue rights are situations that prevent you from being denied a Medigap plan or charged more for one. As stated above, you have these rights during your OEP, but there are also other times you can find yourself with guaranteed issue rights.
- If you have Original Medicare (Medicare Parts A and B) and secondary insurance such as COBRA or a group health plan, once your secondary coverage ends you have 63 days to apply for Medicare Supplement Insurance and avoid medical underwriting.
- If your Medigap coverage ends through no fault of your own, you have 63 calendar days to apply for a new plan.
- If you decide to switch back to Original Medicare from Medicare Advantage or Programs of All-inclusive Care for the Elderly (PACE) within 12 months of the initial change, your window to apply for Medigap starts 60 days before your plan's end date and closes 63 days after the end of coverage.
- If you left Medigap to join a Medicare Advantage or SELECT plan (as long as it is the first time) and want to switch back within 12 months, you fall under trial rights. This means you can purchase the same supplement policy as before.
- If you move outside your Advantage or SELECT service area, your guaranteed issue rights start 60 days before coverage ends and lasts until 63 days after coverage ends.
- If your Medigap or Advantage plan misled you or failed to follow rules, you have 63 days to apply for a new Medigap plan.
Outside of these situations, your application must go through medical underwriting.
Learn more: Medigap Guaranteed Issue
When is the best time to sign up for a Medigap plan?
Truly the best time to sign up for Medicare Supplement Insurance is during your Medigap OEP. Your OEP is unique to you, stating the day you are both 65 and enrolled in Parts A and B. This lasts for 6 months and lets you bypass medical underwriting, since your OEP gives you guaranteed issue rights.
There are some states that have the "birthday rule", which provides an OEP every year for 30 days after your birthday. The exact rules vary by state, and you can learn more here.
Here are the answers to some frequently asked questions about Medigap.
What if I have an older Medigap policy?
You don't have to switch if you have an older plan. Buying a new Medigap policy means you have to give up the old one. Depending on how old your plan is, you won't be able to get it back, and you may lose coverage or savings.
What if I have pre-existing conditions and have had my old Medigap policy for less than six months?
The insurance company may make you wait up to six months before covering any pre-existing conditions. The number of months you've had your current policy must be subtracted from the time you must wait before the new policy begins.
What if my old Medigap policy has a different benefit than my new policy?
No matter how long you've had your current policy, you may still need to wait six months before the new benefit is covered.
What happens if I move out of state?
As long as you still have Original Medicare, you can keep your Medigap plan. If you do decide to switch, keep in mind costs may change and your application may have to go through medical underwriting.
Compare Medigap plans in your area
If you are ready to look at Medigap plans, the easiest way is with our Find a Plan tool. Just enter your zip code and you'll be comparing plans in no time. You can also call us toll-free to schedule a Medicare review and speak to a knowledgeable, licensed Medicare representative.
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