The Medigap open enrollment period (OEP) begins the month a person turns 65, and it lasts for 6 months. There are some rules that apply.
Private insurance companies administer Medigap policies, and on the first day of the month in which a person turns 65 years old, the Medigap OEP begins, and a person may enroll with their chosen plan provider.
In this article, we discuss Medigap plans, and how and when to get one.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A Medigap policy can be held alongside original Medicare, made up of parts A and B. The policies are a Medicare supplement insurance that private companies administer to help fill in Medicare coverage gaps.
Medicare parts A and B pay for many health costs but they do not pay for all healthcare services and supplies. A Medigap plan can help cover some of the out-of-pocket expenses, such as:
- excess charges
Medigap policies only cover one person. If a person and their spouse both want a Medigap policy, each must buy their own.
There are currently 10 different Medigap plans that are identified by letters A, B, C, D, F, G, K, L, M, and N.
All Medigap plans are standardized, and the plan providers must follow certain rules set by Medicare, including the following:
- Each policy of the same letter must include the same benefits. Private insurers can offer more benefits, but they may not offer less.
- If a person holds a Medicare Advantage plan, it is illegal for a private insurer to offer a Medigap plan to them unless they are looking to change back to original Medicare.
- Medigap plans that cover the Part B deductible are no longer available for purchase. This means Medigap plans C and F are no longer sold to those who are newly eligible for Medicare after January 1, 2020.
Federal and state laws regulate Medigap policies. It is important to compare Medigap policies, even if they have the same letter. The cost can vary depending on the private insurer.
State laws may affect private health insurers’ choice when offering plans, but insurers do not have to offer Medigap policies at all.
If they do choose to offer a plan, the insurer must follow Medicare rules, such as:
- Medigap plans A, C, and F must be available to those who qualify.
- Medigap policies cover coinsurance only after a person has met the Medicare deductible.
A person is eligible and can enroll in original Medicare 3 months before the month they turn 65. They continue to be eligible for 3 months after their birth month.
This 7-month period is called the Initial Enrollment Period (IEP).
The month an individual turns 65, and is enrolled in Part B, is the first month of the Medigap OEP.
This period is then open for 6 months and the opportunity for this enrollment period to be repeated or changed is not possible.
A person can compare Medigap plans offered in their state using the Medigap plan finder tool. This service gives facts about the plans offered in-state, likely premium costs, and contact details of plan providers.
If a person enrolls during their 6-month open enrollment, they can buy any Medigap policy sold in their state.
Medigap plan providers cannot deny coverage, even if a person has specific health conditions. Once the enrollment period ends, the rules change.
Private companies do not have to offer Medigap plans after this time, and if they do, the policies may cost more.
If the 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 OEP only.
This is known as medical underwriting, and sometimes, health conditions can be excluded from coverage altogether.
When a private health insurance company decides underwriting should take place, an impartial company evaluates a person for health concerns.
This helps the private insurer decide if they want to sell a policy and how much to charge. People have a guaranteed right to buy a Medigap policy in two situations.
This happens during their open enrollment and if they have a guaranteed issue right. During open enrollment and guaranteed issue right, private companies cannot:
- refuse to sell a policy
- make a person wait for coverage
- charge more because of health problems
A guaranteed issue right, also known as Medigap protections, is given when:
- a person has original Medicare as well as employer or union coverage that is ending
- a person moves out of a Medicare SELECT or Medicare Advantage plan service area
- the private insurance company administering the plan files for bankruptcy, causing a person to lose their coverage
- a person is not responsible for their loss of coverage
- a person leaves a Medicare Advantage plan or Medigap plan because the company misled them or the company has not followed Medicare rules
- a person has a Medicare Advantage plan, and the company is planning to stop working with Medicare
When a person first became eligible for Medicare, they may have immediately registered in a Medicare Advantage plan, or in a Program of All-inclusive Care for the Elderly (PACE).
If an individual has held either of these plan options for less than a year and changes their mind, they are able to revert to original Medicare and have the opportunity to enroll in Medigap without the possibility of underwriting.
Additionally, if someone has dropped their Medigap policy to join a Medicare Advantage or Medicare SELECT plan for the first time, and have been in the plan for less than 12 months, they can switch back without having underwriting applied.
People who have group health coverage with an employer or union may choose to wait to enroll in Medicare Part B.
When this coverage ends, a person may enroll in Medicare without a late enrollment penalty. In this case, the Medigap open enrollment period begins after the group health coverage ends.
Medigap open enrollment begins when a person enrolls in Medicare Part B, even when they are covered by their employer. People get the best price during Medigap open enrollment.
Medigap is supplemental insurance that helps pay for “coverage gaps” in Medicare parts A and B.
The Medicare supplement OEP begins the month a person turns 65 for those eligible for original Medicare and are enrolled in Part B. It ends 6 months later.
Those who delay enrolling may not be eligible for a Medigap plan or they may have to pay a higher premium. Private companies can use medical underwriting to evaluate a person’s health concerns and set a price for the premium or deny a policy altogether.
Under specific circumstances, a person has guaranteed issue rights and trial rights for Medigap plans. This means they can buy a policy after the OEP without penalty.