People With Medicare
Can I change coverage?
There are many reasons you may want to change your coverage. Maybe you are now able to get other insurance, such as Medicaid. Or, maybe you were in a Medicare Advantage plan and the plan no longer works where you live. Or, maybe your health has gotten worse, and now you need more benefits.
You may be able to make changes to your coverage. But there are rules you must follow - and only certain times when you can change it. Be sure to keep these in mind when you want to buy a Medigap policy.
Can I switch to another Medigap plan?
There are rules for switching your Medigap plan. In most cases, you will have to apply for your new plan. Sometimes the insurance company can deny you coverage, even if you had your previous Medigap for a long time.
Be sure to keep your coverage until you understand what you can and cannot do. Also, be sure you know if you will have to wait to have your pre-existing conditions covered. And, if so, for how long. Want personal help?
Can I buy a Medigap policy outside of my open enrollment period?
In some situations, you have the right to buy a Medigap policy outside of your Medigap Open Enrollment Period. These rights are called "Medigap protections."
They are also called guaranteed issue rights, because the law says that insurance companies must sell or "issue" you a Medigap policy even if you have health problems. And this way, if you lose your current insurance, such as coverage through your job or a Medicare Advantage plan, you get the chance again to buy a Medigap policy.
In most cases, you must buy your new Medigap plan within 63 days of the time your previous health coverage ends. In these cases, you will not have to wait to get covered.
You get Medicare protections, or guaranteed issue rights, if:
|Type of Situation||Plans You Can Buy|
|Your Medicare Advantage Plan is leaving the Medicare program or will stop serving your area.||Medigap plans A, B, C, F, K, or L|
|You have employer group health plan coverage that pays after Medicare, and that plan is ending. This includes retiree plans and COBRA.||Medigap plans A, B, C, F, K, or L|
|You have a Medicare SELECT plan, and you move out of the plan's service area.||Medigap plans A, B, C, F, K, or L|
|You joined a Medicare Advantage Plan when you were first eligible for Medicare at age 65. And you decide you want to leave within the first year of joining, or 12-month trial period.||Any Medigap plan sold in your state|
|You dropped a Medigap policy and joined a Medicare Advantage Plan for the first time. Now you want to leave.
Note: You only have this guaranteed issue right if you have been in the plan less than a year and are in your 12-month trial period.
|Any Medigap plan you had before you joined a Medicare Advantage Plan, if the same company sells it.
If it is not available, Medigap plans A, B, C, F, K, or L
|You lose your coverage through no fault of your own.
For example, the insurance company goes bankrupt or ends.
|Medigap plans A, B, C, F, K, or L|
|You leave your plan because your Medicare Advantage Plan or Medigap insurance company has not followed the rules.
For example, the marketing materials were misleading, or quality standards were not met.
|Medigap plans A, B, C, F, K, or L|
Confused about your situation? Get personal help.
Can I suspend my coverage if I get a job?
If you get other health insurance, you may be able to put your Medigap policy on hold, or suspend it.
You can suspend your Medigap policy if:
- You have Medicare and a Medigap policy when you are under age 65, and you go back to a job that offers health insurance, or
- You are the dependent, spouse, or adult child of someone who gets a job that offers health insurance.
You will need to contact your Medigap insurance company and let them know. You can suspend your Medigap:
- At any time while you have employer group health insurance, and
- As long as you are eligible to get Medicare because of a disability.
If you lose your job's health insurance coverage, you can get your Medigap back. You will need to contact your Medigap company and let them know within 90 days of losing your job's coverage. Your Medigap coverage will begin the day you lost your job's coverage.
Note: This right to suspend your Medigap policy if you get employer health insurance is only for people with Medicare and Medigap who are not yet 65.
What if I have Medicare and Medicaid?
If you have a Medigap policy and then get Medicaid, there are a few things you should know:
- You can put your Medigap policy on hold, or suspend it, within 90 days of getting Medicaid. You send the company a letter to suspend your policy. Your insurance company can tell you exactly what to say in your letter and where to send it.
- You can suspend your Medigap policy for up to 2 years. Some people choose to keep their Medigap policy active so they can see doctors that do not accept Medicaid. This can be expensive, so carefully consider if you need both.
- If you already have Medicaid, an insurance company cannot by law sell you a Medigap policy except if:
- Medicaid pays your Medigap premium
- Medicaid only pays all or part of your Medicare Part B premium