The Medigap open enrollment period is a one-time, individualized six-month timeframe for each Medicare beneficiary. During this period, you may enroll in a Medigap plan to help with medical costs not covered by original Medicare (Parts A and B). In this article, we’ll explain what Medigap is and why you don’t want to miss your Medigap open enrollment period.
What is Medigap?
Medigap is another name for Medicare Supplement Insurance. It is a health insurance policy sold by private insurance companies to bridge the gap between health care costs and the coverage of original Medicare plans.
With original Medicare (Parts A and B), after Medicare pays its part, any remaining costs are your responsibility and come out of your pocket. That is the “gap.” Together, your Medigap policy and Medicare Parts A and B provide broader coverage for health care costs and reduce out-of-pocket medical expenses.
10 standardized Medigap plans
There are 10 different types of Medigap plans with varying coverage, coinsurance, copayments, deductibles, and out-of-pocket limits. These supplemental insurance plans are named alphabetically from Medigap A to Medigap N.
Congress has standardized the plans, and the states regulate them. All plans of the same type must offer the same benefits. For example, all Medigap A benefits must be the same, no matter which company sells the plan.
Who sells Medigap plans?
Private insurance companies sell Medigap plans, and while coverage benefits are standardized per plan, premiums can vary by company, making it essential for consumers to compare prices before selecting a Medigap plan.
Who buys Medigap plans?
Medigap enrollment is voluntary, but an estimated 14.6 million Medicare beneficiaries are enrolled in Medigap plans to reduce out-of-pocket medical costs for services not covered by original Medicare.
About the Medigap open enrollment period
According to Medicare.gov, federal law requires individuals to receive a one-time, six-month Medigap open enrollment period. During this period, you can select and enroll in any of the Medigap policies sold in your state. The benefits of this federally mandated open enrollment period include the following:
- You can shop around and compare pricing among policies before selecting a plan.
- You have the widest selection of plans during open enrollment.
- You may enroll in any Medigap policy you choose.
- You must be accepted and cannot be turned down for preexisting health conditions.
- Policies are guaranteed to be renewed as long as premiums are paid on time.
Note: This is a strict, one-time period for each individual. Unlike annual open enrollment for other private health insurance plans, Medigap’s open enrollment period happens just once. You do not need to enroll in subsequent years; renewal is guaranteed as long as you keep paying.
When does the Medigap open enrollment period start and end?
Because each individual gets only one Medigap open enrollment period, the start and end dates are also individualized. Your open enrollment period begins the first day of the month you have Medicare Part B and are 65 or older. It ends six months later.
For example, if you are 65 and enroll in Medicare Part B in April, your Medigap open enrollment period begins right after you enroll and ends in September.
Because the time period is limited, it’s a good idea to start thinking about Medigap plans around when you first become eligible to enroll in Medicare Part B: three months before you turn 65.
Who is eligible for the open enrollment period?
To be eligible to enroll in a Medigap plan, a person must be:
- A Medicare beneficiary.
- Enrolled in Medicare Part A and Part B.
- Not enrolled in a Medicare Advantage plan.
- Not enrolled in a Medicaid plan.
Medicare.gov offers an online Medigap enrollment eligibility checker to help you with the federal enrollment requirements.
You should check with your state to learn if any guidelines vary. You can find your state’s insurance department through the National Association of Insurance Commissioners (NAIC) website.
What happens if you miss the Medigap open enrollment period?
If you miss your one-time open enrollment period, the situation changes:
- There is no longer a federal guarantee that a company will sell you a Medigap policy.
- The insurance companies can use medical underwriting to assess your health and deny you coverage.
- You will have fewer policy options to choose from.
- If you can get coverage, monthly premiums may be higher because of medical underwriting.
Medicare advises checking with your state to determine if state law provides additional rights or enrollment periods.
Special enrollment periods
In special instances, you may have Medigap protections referred to as “guaranteed issue rights” or “Medigap protections” that require companies to sell you a Medigap policy outside of the Medigap open enrollment period.
For instance, if you have a Medicare Advantage plan, but your plan leaves Medicare or you move out of its coverage area, you may enroll in most Medigap plans 60 days before or 63 days after your Medicare Advantage plan coverage ends.
Several situations related to coverage ending or changing may qualify you for a similar exception. Call 1-800-MEDICARE to learn your options.
Depending on special rights and guaranteed issue rules, your state may allow special enrollment. A limited number of states allow for open enrollment year-round, guaranteeing some or all the protections offered during the federal government’s six-month open enrollment period. Other states have special times each year, such as around the beneficiary’s birthday, during which Medigap enrollment is allowed.
Be sure you enroll during the Medigap open enrollment period
By enrolling in a Medigap plan during the Medigap open enrollment period, you can be sure of the granted federal protections, most notably the security of being accepted. Insurance companies cannot deny you coverage during your six-month open enrollment period. In addition, during the Medigap open enrollment period, you have a greater selection of plans to choose from and may even benefit from more competitive pricing.
