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When is Medigap Open Enrollment?

Don’t confuse Medigap open enrollment with Medicare Advantage open enrollment3D Figure with Red Question Marks

Whether you are interested in buying a Medigap policy or enrolling in a Medicare Advantage plan there is a time to do it. It’s in your best interests to understand the differences between the enrollment periods and when you can enroll.

Missing the Medigap open enrollment period could mean a denial of coverage due to pre-existing health conditions or an increased premium.

Missing the annual Open Enrollment Period for Medicare Advantage and Part D could leave you without those coverage options for the following calendar year.

The following article addresses when the Medigap open enrollment period takes place and why it’s the best time to buy a Medicare supplement policy.

Medigap open enrollment – the best time to buy a Medigap policy

The open enrollment for Medigap lasts for 6 months. The first day of your open enrollment begins on the first day of the month that you are both 65 or older and are enrolled in Medicare Part B. Some States have enrollment periods for Medicare recipients under 65. Check your State laws if you fall into that category.

Insurance companies that sell Medicare supplemental insurance will accept an application when you have received notice of your Medicare claim number from Social Security.

During the open enrollment period companies selling Medigap insurance cannot use medical underwriting to determine whether or not you can purchase a policy. This is the main reason why your open enrollment period is the best time to purchase a Medicare supplement.

Insurance companies can not:

  • Refuse to sell you any Medigap policy that it sells
  • Make you wait for effective coverage (some exceptions apply)
  • Charge you a higher premium due to a health condition

The exception to not making you wait for coverage involves pre-existing conditions. An insurance company may make you wait to cover pre-existing conditions if you have received treatment or been diagnosed within the previous 6 months. If certain pre-existing conditions are not covered, the insurance company can refuse to pay related claims for 6 months. But original Medicare will continue to pay those claims.

It’s possible to shorten or eliminate waiting periods for pre-existing conditions if you have had creditable coverage. If you have had at least 6 months of prior creditable coverage prior to your Medigap effective date without more than a 63 day lapse, the insurance company cannot make you wait for coverage related to your pre-existing conditions.

Discuss you previous coverage with your insurance agent to determine whether it meets the criteria of creditable coverage.

Learn About Medigap Guaranteed Issue Rights


Buying a Medicare supplement policy

If you are in your open enrollment period and a Medicare supplement policy is affordable, this is the time to do it. Make sure the plan you are considering is clearly marked “Medicare Supplement Insurance”. In most states plans are standardized and designated by the letters A through N.
A standardized policy will include the same benefits no matter which company sells it. Plan F from Mutual of Omaha will have the same coverage as Plan F from AARP UnitedHealthCare. Some plans may include ancillary benefits such as discounts related to health and wellness products and services. You will need to determine if they offer value.

Other than any extras, the differences between companies will be your perceived level of customer service and in many cases, the services of a trusted agent. If anyone tells you that your premiums will not increase, they are being less than honest. They all increase!

Given the standardization of Medicare supplement policies, if you are in your Medigap open enrollment period, you would be wise to start comparison shopping now.

8 comments

  1. I’m trying to learn ablut the medicare supplements available prior to turning 65.

    I will be 65 in about 6 months or so.

  2. I’m 57 and mentally disabled. I do ok, but this is so confusing. I’m already in the donut hole and sunk until 2010 (your the only place I got an answer as to when it ends. I finally found out what Plan F is, thank you. But after 4 weeks of research before picking a Plan D, I’m still paying (credit) out the nose for prescrition drugs.
    Where does the government think I/we can just come up with 4 grand to cover the gap on a SSD income?

  3. Deborah, You may want to speak with someone in your local Area Council on Aging office to review your situation. If you income is only SSD you may qualify for extra help with your prescription costs.

  4. Richard Petrovic

    Dear David, I’m 71 yrs. old. I currently have Medicare A/B plus Mutual of Omaha plan F. M of O just advised me of a forthcoming rate increase in Aug. In the interest of saving money I am thinking of switching to Medicare Advantage although I’m a bit confused. Would Medicare Advantage just be replacing my supplemental which is my intention or does it replace my Medicare. If it replaces Medicare what do I do for supplemental. Thanking you in advance.

    Richard

  5. Richard, An Advantage plan really does neither. With an a Medicare Advantage plan you are actually still enrolled in Medicare but receiving your benefits from a private company which is approved and contracted to do so. You will still of course pay your Part B premium and may or may not pay a premium for your Advantage plan. You may have plans such as AARP MedicareComplete available with a $0 monthly premium.

    The Advantage plan will require certain cost sharing for medical services. You should review a plan’s Summary of Benefits to get the full details. When you are enrolled in a Medicare Advantage plan, you cannot also be enrolled in a Medicare supplement. Also, unless you are entitled to a Special Enrollment Period, you will need to wait until the Annual Open Enrollment Period to apply (October 15 – December 7). Your Advantage plan would then become effective January 1st.

  6. i am looking for medicare suplement to pay the 20% after medicare. Is there a booklet to explain?

  7. M. Daniels, Yes. Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. This is an official publication and should answer all your questions.

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