When Should You Purchase a Medicare Supplement Plan?

Open Enrollment

Buying a Medigap policy during your 6-month Medigap open enrollment period is the best way; mainly because you can buy any supplement policy sold in your state without medical underwriting; even if you have health problems. This period begins the first day of the month you turn 65 and are enrolled in Medicare Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November. After this enrollment period, you may have more difficulty buying a Medigap policy. You will likely be medically underwritten, and If you’re able to buy one, it may cost more.

During open enrollment, you may purchase any Medicare Supplement policy the company sells in your area, even if you have health problems, with no additional cost.

Outside Open Enrollment

If you apply for Medigap coverage after your open enrollment period, you will usually have to pass the company’s medical underwriting requirements, with no guarantee of eligibility.
There are some exceptions:

  1. In cases of End Stage Renal Disease (ESRD) or other disability in people under age 65, exceptions will vary by state. The official Medicare.gov website should be consulted for details.
  2. If you are in a Medicare Advantage Plan, and that Plan is leaving Medicare or no longer servicing your area, or if you move out of the Plan’s service area, you have a guaranteed right to purchase a Medigap Plan.
  3. If you have original Medicare (Parts A and B), and an employer-sponsored medical plan that pays after Medicare pays, and that plan is ending, you have a guaranteed right. Usually that must be exercised in the first 63 days after coverage ends, although there are further exceptions.
  4. If you joined a Medicare Advantage Plan when first eligible at age 65, and want to switch to original Medicare and a supplement, you have a guaranteed “trial right” during the first 12 months.
  5. If you dropped original Medicare and a supplement to join a Medicare Advantage Plan, and want to switch back, the is a guaranteed “trial right” during the first 12 months.
  6. If a Medigap company goes bankrupt, or you otherwise lose coverage through no fault of your own, or a Medigap or Medicare Advantage Company has misled you, you will generally have a 63 day period.

Pre-Existing Conditions 

Although the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage if you have a pre-existing condition.  In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs related to those pre-existing health problems for up to 6 months (“pre-existing condition waiting period”). After those 6 months, the Medigap policy will cover your pre-existing condition.

Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.

Note: It is important to remember that Original Medicare will still cover the condition, even if the Medigap policy won’t cover your out-of-pocket costs, but you are responsible for coinsurance or copayment.

Click here to download a PDF of this Guide.

Please contact me for a free comparison plans in your area. (434) 373-0051.