People change. So do their medical needs and budgets. But are you allowed to switch Medigap plans?
Medigap plans change, too. They may go out of business, forcing you to look for another plan. They may also slap policyholders with rate increases.
Meanwhile, other plans may become available in your area with lower premiums or a better pricing structure for you.
If this happens, you should consider shopping around for a better Medigap plan. One that more closely suits your needs and budget.
When this happens, it’s worth exploring your options. Finding a Medigap plan that fits your needs and budget can make a big difference.
This blog post will discuss the benefits of switching to a new Medigap policy. It will also discuss the advantages and disadvantages of switching from your Medigap plan to Medi-Share 65+, a more affordable health sharing plan.
Benefits of Switching to a New Medigap Plan
Depending on your circumstances, switching Medigap plans may bring the following benefits:
- Lower premiums. Switching Medigap plans can help you find a plan with lower monthly premiums, saving you money.
- Change in healthcare needs. If your health condition has changed, switching to a different Medigap plan can ensure you have coverage that meets your current needs, such as prescription drugs or specialized services.
- Better customer service. If you’re unhappy with your current plan’s customer service, switching to a different Medigap plan can provide better support and responsiveness.
- Expanded provider network. Switching to a different plan can give you access to a broader network of healthcare professionals and hospitals.
- Additional benefits. Some Medigap carriers also offer extra benefits like vision, dental, or hearing coverage, which may be important to you.
- Better rate stability. Switching plans can provide more rate stability, protecting you from significant premium increases.
- Travel coverage. Some Medigap plans offer travel benefits that help you pay for care outside of the U.S. If yours doesn’t, and you plan to travel outside of the United States, you should consider switching to a Medigap plan that covers foreign travel. Among the standardized Medigap plans, Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N may include foreign travel benefits.
However, plans F and C are no longer available to new enrollees.
Read more about Switching to a New Medigap Policy here.
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When Can I Switch Medigap Plans?
While you can apply to switch Medigap plans at any time, acceptance is only guaranteed under certain conditions.
You have guaranteed enrollment rights to a new Medigap policy if these circumstances apply.
- Your Medigap Open Enrollment Period (OEP). This is a six-month period that begins when you are both 65 years old or older and enrolled in Medicare Part B. During this period, you have guaranteed issue rights, meaning that insurance companies cannot deny you coverage or charge you higher premiums based on your health condition
- During A Special Enrollment Period. You have guaranteed issue rights if you lose certain types of health coverage, such as employer-sponsored coverage or a Medicare Advantage plan, or if your current Medigap plan is ending its coverage or going out of business.In these situations, you have a limited timeframe to switch to a new Medigap plan without being subject to medical underwriting.
To take advantage of a special enrollment period, you must complete your enrollment into your new plan not less than 63 days after your previous coverage ends.
Keep any letters, notices, emails or claim denials you receive. You may need them when you apply to your new plan to prove that your previous coverage was terminated, and therefore you qualify for a Special Enrollment Period. - During Your Birthday Enrollment Period. A few states let you switch Medigap plans with equal or lesser benefits without medical underwriting for a brief window of time around your birthday every year.This privilege is not available in most states. But if you live in Maryland, California, Oregon, Illinois. Nevada, or Idaho, you may want to schedule a Medigap checkup close to your birthday to take advantage of this provision.
- Special Circumstances: Every state has rules for Medigap guaranteed issuance in specific situations, such as if you were misled when you first enrolled. These rare cases, known as Medigap Special Enrollment or Special Circumstances, allow you to switch plans without medical underwriting if you qualify.
States Allowing Medigap Plan Changes Without Medical Underwriting
Several states have enacted laws that allow you to switch Medigap plans without undergoing medical underwriting for a brief window of time around your birthday every year.
Below are the details for each state’s rules:
- Medigap Birthday Rule States: In California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon, you can switch to a different Medigap plan around your birthday each year without medical questions. This state-specific rule ensures easier transitions between plans.
- Guaranteed Issue States: Connecticut, New York, Massachusetts, Rhode Island, and Washington* offer guaranteed issue rights year-round, allowing you to change Medigap plans anytime without underwriting.
*In Washington, you must switch to the same plan from another insurer to avoid medical underwriting.
- Medigap Anniversary Rule State: Missouri allows you to switch plans within 30 days of the policy’s anniversary date.
- Massachusetts Annual Open Enrollment: Massachusetts provides an annual open enrollment period for switching Medigap plans from February 1 to March 31.
- Maine’s Flexible Switching Rule: In Maine, you can switch to a Medigap plan with the same or fewer benefits at any time during the year.
These state-specific provisions make it easier for you to adjust your Medigap coverage to better meet your needs without the worry of medical underwriting. For details specific to your state, and to enroll, contact a Personal Benefits Manager.
Supercharge Your Savings: Switch From Medigap to a Healthshare Plan
Yes, you can switch from Medigap to a health share plan at any time during the year.
Healthshare plans don’t have limited open enrollment periods or special enrollment periods. However, health sharing plans generally impose a waiting period before they will share costs related to any pre-existing conditions.
What are Health sharing plans?
A health sharing plan, also known as a health sharing ministry or healthcare sharing ministry, is a non-insurance alternative to traditional Medicare supplement insurance. It is a form of cost-sharing among members who have similar religious or ethical beliefs.
Medi-Share 65+
Medicare beneficiaries can enroll in Medi-Share 65+, an innovative and affordable health share plan that covers most of the same benefits as the popular Medigap Plan GPlan F or Plan N – at a much lower monthly cost in most areas.
With Medi-Share 65+, you are only responsible for the first $500 in qualified out-of-pocket household expenses (your annual household portion, or AHP) for medical services ordinarily covered under Medicare Parts A and B.
Once your household meets that $500 annual contribution, 100% of your eligible medical bills that Medicare does not pay are shared by your fellow Medi-Share members.
Typically, these costs include copays, co-insurance, deductibles, and in some states, Medicare “excess charges,” which are fees charged by doctors in excess of standard Medicare reimbursement rates.
As of mid 2024, Medicare enrollees from age 65 through 74 can enroll in Medi-Share 65+ for just $99 per month. From age 75 and up, you can enroll in Medi-Share 65+ for just $150.
Click here for full information on the Medi-Share 65+ healthsharing alternative to Medigap.
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Prescription Drugs
Neither Medigap nor Medi-Share includes prescription drug coverage. Most people buy a standalone Medicare Part D plan to work alongside their Medigap or Medi-Share 65+ plan to help them pay for high-cost prescription drugs.
Medi-Share 65+ offers a great discount program, allowing members to buy quality generic prescription drugs at up to 80% less than standard retail pharmacy prices.
Medigap enrollees can take advantage of Pharmaceutical Assistance Programs to help pay for medications. These programs often provide significant savings on both generic and brand-name drugs, making medications more affordable for seniors.
To ensure you get the most comprehensive coverage, compare different Medicare Part D plans and prescription discount programs to find the best fit for your specific medication needs.
What To Consider When Switching Medigap Plans
Here are some of the different factors you should consider before you drop your current Medigap coverage in favor of something else:
- Benefits and coverages in the plan
- Monthly premiums
- Projected premium increases
- Customer reviews
- Financial strength and stability of the insurance company
- Foreign travel benefits
- Care networks (if switching out of Medigap)
- Deductibles
- Coinsurance and copays
- Medicare excess charge
- Additional benefits
Your Personal Benefits Manager can save you hours of hassle by helping you research many different plans and narrow down your options. They will ensure you are enrolled in the best possible plan to suit your individual circumstances.
How To Switch Medigap Plans
Switching Medigap plans or transitioning from Medigap to the Medi-Share 65+ health-sharing alternative is straightforward with the right guidance.
Here’s how to make the switch:
- Consult a Personal Benefits Manager: Schedule an appointment with a Personal Benefits Manager These experts are highly trained and experienced in both traditional health insurance and healthsharing plans. They will help you understand your options and find the best plan for your needs.
- Evaluate your options: Your Benefits Manager will help you compare Medigap plans and the Medi-Share 65+ alternative. They will explain factors such as premiums, coverage, and additional benefits to ensure you make an informed decision.
- Apply for the new plan: Once you’ve chosen a new plan, your Benefits Manager will guide you through the application process. This includes completing necessary paperwork and providing any required documentation.
- Wait for approval: After submitting your application, wait for approval from the new plan. This step is crucial to ensure you have continuous coverage and avoid any gaps.
- Cancel your existing policy: Once your new plan is approved and enrollment is complete, your Benefits Manager will help you cancel your existing Medigap policy. They will ensure the transition is seamless and you do not experience a break in coverage.
- Review your new coverage: After the switch, take the time to review your new coverage details. Make sure you understand the benefits and any new procedures or requirements.
When you consult with a Personal Benefits Manager, you can confidently switch your Medigap plan or move to Medi-Share 65+, knowing you have the support needed to avoid any risks and maintain continuous coverage.
Here are some additional blogs on th topic: How to Avoid this Costly Medicare Mistake | What’s New in Medicare for 2023? | What Can I Do During Medicare Open Enrollment?| What To Do When You Receive Your Medicare Annual Notice of Change Letter
Here are some additional pages related to this article: Medicare Supplement Plan G | Medicare Advantage Plans
Remember to consult with healthcare providers, review your specific Medicare plan, and explore community resources for comprehensive care and assistance throughout the Alzheimer’s and dementia journey.
FAQs on Switching Medigap Plans
Can I switch Medigap plans at any time?
Yes, you can switch Medigap plans at any time throughout the year. Unlike Medicare Advantage plans, Medigap plans do not have specific enrollment periods.
Will I be subject to medical underwriting when switching Medigap plans?
Unless you qualify for a guaranteed issue right or are within your Medigap Open Enrollment Period (OEP), you may be subject to medical underwriting when switching Medigap plans. This means the insurance company can consider your health history and may charge higher premiums or deny coverage based on pre-existing conditions.
When is the Medigap Open Enrollment Period (OEP)?
The Medigap Open Enrollment Period is a six-month period that starts when you are 65 years old or older and you are enrolled in Medicare Part B.
What are guaranteed issue rights and when do they apply?
Guaranteed issue rights protect you from medical underwriting. They apply in specific situations, such as losing certain types of health coverage, your current Medigap plan ending its coverage, or your Medigap plan going out of business. These rights provide a limited timeframe to switch to a new Medigap plan without being subject to medical underwriting.
Can I switch to any Medigap plan I want?
You can switch to any available Medigap plan, but your ability to get coverage at the desired plan and rate may depend on your health history and the underwriting practices of the insurance company.
Are there any waiting periods when switching Medigap plans?
If you had prior creditable coverage, there generally should not be any waiting periods for pre-existing conditions when switching Medigap plans. However, if you have a significant gap in coverage, the new Medigap plan may impose a waiting period before covering pre-existing conditions.
Should I cancel my old Medigap policy before applying for a new one?
It is recommended to wait until your new Medigap policy is approved before canceling your old one to avoid a gap in coverage. Make sure you have the new policy in place before terminating the existing one.
Can I keep my same insurance company when switching Medigap plans?
In most cases, you can switch Medigap plans within the same insurance company. However, you should confirm with your Personal Benefits Manager or your current carrier if they allow switching between their different Medigap plans.
The current plan may not be the best match for you. Sometimes you can get a much better value by switching carriers altogether.
Will I have to start over with a new deductible when switching Medigap plans?
If you switch between Medigap plans with different deductibles, you may have to meet the new plan’s deductible before it provides coverage. However, any deductibles you’ve already met under your previous Medigap plan should be credited towards the new plan.
Can I switch Medigap plans if I have a pre-existing condition?
If you are outside your Medigap Open Enrollment Period or do not have a guaranteed issue right, the new Medigap plan may review your health history and could charge higher premiums or deny coverage based on pre-existing conditions.
However, if you have guaranteed issue rights, you cannot be turned down for a Medigap plan.
Christine Corsini is one of your Personal Benefits Managers at MediGap Advisors. She loves working for Medigap Advisors especially helping clients choose the right Medicare plan.