Your Rights To Buy A Medigap Policy In Certain Situations

You have the right to buy the Medigap plan of your choice during your Medigap open enrollment period. Your Medigap open enrollment period lasts for six months. It starts on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. Once you enroll in Medicare Part B, the six months Medigap open enrollment period starts and cannot be changed. During this open enrollment period, an insurance company cannot deny you insurance coverage, place conditions on a policy (like making you wait for coverage to start), or change the price of a policy because of past or present health problems.

If you apply for a Medigap plan after your Medigap open enrollment period has ended, the Medigap insurance company is allowed to use medical underwriting to decide whether to accept your application, and how much to charge you for the policy.

There are a few situations involving health care coverage changes where you may have the right to get a Medigap policy after your Medigap open enrollment period has ended. In these situations, the insurance company cannot deny you insurance coverage, place conditions on the policy (like making you wait for coverage to start), or change the price of a policy because of past or present health problems.

If you lose certain types of health care coverage, 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 issue you a policy.

Medigap protections are important because without them, if you do not buy a Medigap policy during your Medigap open enrollment period, an insurance company can refuse to sell you a policy, or you may be charged more for the policy. In addition, if you drop your Medigap policy, you may not be able to get it back except in very limited circumstances.

You should not wait until your health coverage has almost ended before you apply for a Medigap policy. You can apply for a Medigap policy early (while you are still in your health plan) and choose to start your Medigap coverage the day after your health plan coverage ends. This will prevent gaps in your health coverage.

Summary of Medigap Protections
There are a few situations involving health coverage changes where you may have a guaranteed issue right to buy a Medigap policy.

For example:

1. Your Medicare managed care plan, Private Fee-for-Service plan, PACE provider, or Medicare managed care demonstration project coverage ends because the plan is leaving the Medicare program or stops giving care in your area, or

2. Your health coverage ends because of reasons other than a plan leaving the Medicare program, or

3. You dropped your Medigap policy to join a Medicare managed care plan, Private Fee-for-Service plan, or PACE program and then leave the plan within one year after joining. Or you buy a Medicare SELECT policy for the first time and drop the policy within one year after buying, or

4. You joined a Medicare health plan (like a Medicare managed care plan with a Medicare + Choice contract, or Private Fee-for-Service plan) or PACE program when you first became eligible for Medicare at age 65 and you leave the plan within one year of joining, or

5. A change in your circumstances gives you the right to leave (dis-enroll from) your plan.

In order to get these Medigap protections, you must meet certain conditions. All rights to buy Medigap policies under the following situations include Medicare SELECT policies since they are a type of Medigap policy. For more detailed on your rights and protections, you may want to read Medigap Policies and Procedures.

The Medigap protections in this section are from federal law. Many states provide more Medigap protections than federal law. Call your State Health Insurance Assistance Program or State Insurance Department for more information.

Note: There may be times when more than one of these situations applies to you. When this happens, you can choose the protection that gives you the best choice of policies.

For example:

If both situations #1 and #4 apply to you, you may have the right to buy any Medigap policy.

• Situation #1 limits your choices to only Medigap plans A, B, C, or F that are sold in your state.
• Situation #4 offers you the best choice by allowing you to buy any Medigap policy that is sold in your state.

Source: US Gov, Medicare site.