The best time to enroll in a Medigap policy is during the six-month Open Enrollment Period, which begins the month you turn 65 and have Medicare Part B.
During this period, you cannot be denied coverage or charged more due to pre-existing conditions. But if you missed your Medigap Open Enrollment deadline because you went with a Medicare Advantage Plan instead, or thought Medicare alone would be enough, it’s not too late!
You can apply for a Medigap policy at any time of the year, so you do have options. We’ll take a look at a few of them in this article. And you can always seek advice from a Medicare expert at any time who can help guide you based on your personal situation.
What You Need to Know
If you apply for a Medigap policy outside of the Open Enrollment Period, insurance companies can require medical underwriting.
This means they can deny coverage or charge higher premiums based on your current health conditions.
Although there are a few circumstances where this may not be the case.
Get a Free Medicare Supplement Quote
Guaranteed Issue Rights for Medigap Policies
Guaranteed issue rights, also known as “Medigap protections,” are specific situations that allow Medicare beneficiaries to purchase a Medigap (Medicare Supplement) policy without going through medical underwriting or facing pre-existing condition exclusions.
These rights provide an opportunity to obtain a Medigap plan outside of the initial 6-month Medigap Open Enrollment Period, ensuring access to coverage regardless of your health status.
Some common scenarios that trigger guaranteed issue rights include:
- Losing Prior Coverage. If you lose your existing health coverage through no fault of your own, such as your employer or insurance company terminating the plan, you qualify for guaranteed issue rights. This allows you to enroll in a Medigap policy without medical underwriting or pre-existing condition waiting periods, as long as you apply within 63 days of losing your previous coverage.
- Moving Out of Your Plan’s Service Area. If you have a Medicare Advantage plan or a Medicare SELECT policy and you move out of the plan’s service area, you have guaranteed issue rights to purchase a Medigap policy in your new location without undergoing medical screening.
Trial Rights for Medicare Advantage Plans
If you enroll in a Medicare Advantage plan when you first become eligible for Medicare and decide to switch back to Original Medicare within the first 12 months, you have a “trial right” that allows you to purchase a Medigap policy without medical underwriting.
This trial right applies only once.
By taking advantage of this option, you can secure a Medigap policy without the possible issues posed by medical underwriting, such as higher premiums or denial of coverage based on your health history.
*It’s important to note that the specific Medigap plans available during a guaranteed issue period may vary, and you must apply within the specified timeframe and provide proof of your qualifying situation.
State-Specific Protections
Some states offer additional protections that allow for more flexibility in purchasing Medigap policies outside the standard enrollment periods.
It’s advisable to check with your State Health Insurance Assistance Program (SHIP) or State Department of Insurance for specific state laws.
Additional Protections
Some states have additional rules that provide more opportunities to enroll in a Medigap policy without medical underwriting.
For example, certain states have a “birthday rule” where you can enroll around your birthday, or have other specific periods during which you can switch Medigap plans without underwriting.
Learn More: Can I Change or Switch My Medigap Plan?
Applying for Medigap Late Enrollment
If you don’t meet any of the above conditions and want to purchase a Medigap policy outside of the Open Enrollment Period, insurance companies can use medical underwriting to determine your eligibility and premiums.
Depending on your health status, you may have fewer policy options and higher costs.
There are other programs you may want to consider as an alternative.
Medicare Advantage (Part C) Plans
If you have no health issues or pre-existing conditions, you can look into a Medicare Advantage plan during open enrollment.
Medicare Advantage plans, offered by private insurance companies, provide all the benefits of Original Medicare (Part A and Part B) and often include additional benefits such as dental, vision, hearing, and prescription drug coverage.
Many Medicare Advantage plans have low or no premiums and set limits on out-of-pocket costs, which can make them more affordable compared to Medigap plans, especially if you are healthy and do not anticipate high medical expenses. These plans often provide coordinated care, which can be beneficial for maintaining your health and avoiding unnecessary services.
However, there are also a few disadvantages to these plans as well:
- Provider Networks – Medicare Advantage plans typically require you to use a narrow network of doctors and hospitals, which doesn’t allow for much flexibility or choice in providers.
- Annual Changes – Benefits, premiums, and provider networks for Medicare Advantage plans can change annually, so it’s important to review your plan each year during the Medicare Open Enrollment Period.
- Prior Authorization – Some services may require prior authorization, which can be inconvenient, and lead to delays in care.
Medicare Advantage Special Needs Plans (SNPs)
If you have health issues or pre-existing conditions and are seeking an alternative to Medigap, a Medicare Advantage Special Needs Plan (SNP) may be a good option.
These plans are specifically designed to provide targeted care for individuals with certain health conditions or circumstances. They include all the benefits of Original Medicare (Part A and Part B) and often additional services tailored to the needs of the specific group they serve.
Types of SNPs:
- Chronic Condition SNPs (C-SNPs) – These plans are for individuals with severe or disabling chronic conditions, such as diabetes, chronic heart failure, or chronic lung disorders. C-SNPs are designed to provide specialized care and support for managing these conditions.
- Dual Eligible SNPs (D-SNPs) – These plans are for individuals who are eligible for both Medicare and Medicaid, providing coordinated benefits from both programs.
- Institutional SNPs (I-SNPs) – These plans are for individuals living in institutions like nursing homes or who require nursing care at home.
To enroll in a C-SNP, your doctor must verify that you have a qualifying chronic condition.
Like other Medicare Advantage plans, SNPs may have network restrictions, so it’s important to ensure that your healthcare providers are included in the plan’s network.
The Affordable Health Sharing Alternative: Medi-Share 65+
Medi-Share 65+ is an affordable non-insurance alternative to Medigap coverage, and offers a way for members to pay for expenses not covered by Original Medicare.
To participate, you must be age 65 or older and be enrolled in both Medicare Parts A and B.
If you have medical expenses that are approved but not paid by Medicare Part A or Part B, you’ll be responsible for the first $500 in expenses per year per household. Your Medi-Share 65+ health sharing pan will generally share 100% of Medicare Part A or B out-of-pocket expenses beyond that.
The program includes benefits such as unlimited telehealth access, discounts on dental and vision care, and a Select Savings Card for additional discounts on medical services not covered by Medicare. There are no network restrictions, and members are free to choose their own providers.
Medi-Share 65+ can be a cost-effective alternative to Medigap for those who align with its Christian values and are looking for a way to manage out-of-pocket medical expenses not covered by Medicare.
Medi-Share 65+ and Pre-Existing Conditions
Medi-Share 65+ normally has a six-month waiting period before costs related to pre-existing conditions become eligible for sharing under the plan.
However, this waiting period is waived if you enroll during your initial Medicare eligibility period or the Medicare Fall Enrollment Period.
Get a Free Medicare Advantage Quote
How To Get (Free!) Help
Medicare options can be tricky to manage on your own.
While you can technically apply for Medigap at any time, the best time to do so is during your initial Open Enrollment Period to avoid higher costs and potential denial of coverage. If you miss this period, check for any applicable guaranteed issue rights or state-specific protections that might allow you to enroll without underwriting. Or look into alternatives like Medicare Advantage or Medi-Share 65+.
A Personal Benefits Manager can review all your options with you, and help you select the most affordable plan to meet all your needs.
For Further Reading: Medigap Shopping Tips – Don’t Overpay!|MediShare 65+ Health Sharing Program vs. Medigap Plan G|Learn Your Medigap ABCs – Comparing The Top Medicare Supplement Insurance Plans in 2024
