There is a lot of confusion about the Medicare Supplement Open Enrollment PeriodDuring the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31.. For one thing, it’s not when most people this it is.
It’s not in the fall.
In this article, we’ll answer the 5 most common questions we get about the Medigap Open Enrollment PeriodUpon initial enrollment in Medicare Part A and Part B, beneficiaries have a one-time, six-month period to buy a Medicare supplement policy with guaranteed issue rights. This is the Medigap Open Enrollment Period., including when it is, how long it lasts, and your rights.
Oh, yes, you still have rights in 2023. But they don’t last very long!
Key Takeaways
- Your Medicare Supplement Open EnrollmentIn health insurance, open enrollment is a period during which a person may enroll in or change their selection of health plan benefits. Health plan enrollment is ordinarily subject to restrictions. is unique to you. It is not a set time of the year.
- Your Medicare Supp Open Enrollment Period starts the first day of the month your Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. is in effect.
- It is a 6-month window when you can get any plan you want without answering health questions (no medical underwriting).
- You can apply for a Medicare Supplement (Medigap) any time of the year.
- Your Medicare Supplement Open Enrollment Period is the only time carriers are prohibited from denying you coverage due to a pre-existing health condition.
- The only way to know if a Medicare Supplement is worth it or not is to get a quote and compare your options.
When is the Medicare Supplement Open Enrollment Period?
It’s easy to be tricked into thinking that open enrollment for Medicare Supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. is in the fall. That’s because Medicare and private insurance companies put out so much information about the Open Enrollment Period for Medicare Advantage and Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each..., which starts on October 15th and ends on December 7th.
But this is not open enrollment for supplemental Medicare insurance. You can change Medicare Supplement plans anytime.
Medigap insurance is not like Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). (Medicare Part CMedicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all...) or Medicare Part D plans (prescription drug coverage). Their benefits, monthly premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , and coverage do change at the beginning of each new year.
Why is that?
Medigap insurance is more like a hospital indemnity policy. It indemnifies you from Medicare’s high out-of-pocket health care costs, including deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. .
That said, private insurance companies can change their rates. So you do need to shop Medigap plans when you are notified of a rate increase.
MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. makes rate shopping very easy (and safe!). We will ask you the following questions:
- Where you live (your zip code)
- Your age
- Your gender
- Your use of tobacco
- The amount of coverage
We’ll send you a free report that shows you all carries, plans, and rates in your area.
No calls. No email spam. Just answer the following questions and we’ll do the rest. No kidding.
We are not an insurance agent or agency. We provide this service to make sure that you have unfettered access to policy information.
The following Medicare Supplement Plans coverage chart will help you compare plans by showing you what each plan covers.
How Does the Medicare Supplement Enrollment Period Work?
When you first turn age 65 and enroll in Medicare Part B, you have a six-month window to enroll in the Medigap plan of your choice. During this period of time, you have Medigap protections, also known as guaranteed issue rightsGuaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting..
Your guaranteed issue right allows you to get the plan you want, from the insurance carrier of your choice, without the fear of being turned down or charged more due to a pre-existing conditionA pre-existing condition is any health problem that occurred before enrolling in a health plan. The Affordable Care Act law made it illegal for health plans to or charge more due to a pre-existing condition.....
If you apply during your enrollment period, insurance companies can’t ask you any questions about your health. They can ask you your age, gender, where you live, and your use of tobacco, but they can’t force you to ask intrusive health questions.
Unless you live in one of the few states that have enacted new guaranteed-issue legislation, your personal open enrollment period is the only time you are guaranteed to get the coverage you want. A few states have slightly different rules, which are covered below.
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Why is My Medicare Supplement Open Enrollment Period So Important?
You may already know that Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. (hospital insurance) and Medicare Part B (medical insurance) have no limits on your out-of-pocket expenses. None.
That’s what makes Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. so scary. Particularly in this day and age of skyrocketing medical costs.
Unlike a Medicare Advantage plan (Medicare Part C), people on Original Medicare have no protection from catastrophic hospital bills. Medicare Advantage health plans have a built-in feature called the MOOP (maximum out-of-pocket) limit.
If you have a Medicare Advantage plan, when your Part A and Part B out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. reach the MOOP, the plan covers all costs for the rest of the year. Not so with Original Medicare.
That’s what a Medigap insurance plan is for. It fills in the gaps in your Medicare health insurance. It’s the MOOP.
However, unlike Medicare Advantage, Medicare Supplement insurance carriers can, and will, turn you down if you have health problems. But not if you buy a policy during your open enrollment period.
That’s why it is so important. If you don’t get an insurance policy when you have Medigap protections, you may be out of luck.
How Long is the Med Supp Open Enrollment Period?
Your Medicare Supplement Open Enrollment Period is a six-month period. But don’t confuse it with your Medicare Initial Enrollment PeriodThe Initial Enrollment Period is a seven-month period when new beneficiaries can enroll in Medicare without a penalty. Most people enroll in Medicare at age 65. (IEP).
Your guaranteed issue right starts the day your Medicare Part B coverage begins. It ends 6 months later.
In other words, if you don’t apply for a Medicare Supplement within the first 6 months of getting your Medicare Part B coverage, you will need to go through medicare underwriting to get a policy.
It’s slightly different than your IEP, which is a 7-month period around your 65th birthday. Your IEP starts 3 calendar months before your birth month, includes the month you turn age 65, and ends three months later.
So, relax, you don’t have to make the decision about which Medicare Supplement plan you want as soon as you sign up for Medicare. You have a little more time to do your research.
Are There Any Exceptions?
If you don’t get Medigap insurance coverage when you are first eligible, you may be out of luck. There are a couple of exceptions.
The first exceptionIn a Medicare Part D plan, an exception is a type of prescription drug coverage determination. You must request an exception, and your doctor must send a supporting statement explaining the medical reason for the... is when you have creditable coverageCreditable coverage refers to health insurance or prescription drug benefits that meet Medicare's minimum qualifications necessary to avoid a penalty. through an employer. If you are still working and have health insurance through your employer, you may have Medigap protections when you retire.
Generally speaking, you have a guaranteed issue right when you have creditable health insurance that changes in some way, like when you retire and no longer have employer health coverage.
Make sure you keep records, including:
- Letters, notices, emails, and claimA request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered. denials that you can use as proof of your coverage being terminated; and
- The postmarked envelopes of notices you can use as proof of when your coverage was terminated.
You will need to send copies of these records with your Medigap application to prove you have Medigap protections.
The other exception is when you use your Medicare Advantage trial right. This right allows you to join a Medicare Advantage plan when you first qualify for Medicare. If you don’t like it, you can switch back to Original Medicare and your Medigap protections are restored.
You can only do this once. You must switch back within the first 12 months.
5 Med Supp Open Enrollment Tips
Here are 5 tips we think will help you during your Medicare Supplement Open Enrollment Period:
- Get enrolled in Medicare Part A and Part B when you are first eligible. If you are not on Social Security, it is not automatic. You can start the process 3 months prior to turning age 65.
- Start shopping Medicare Supplement rates and companies early. In most states, you will have a couple of dozen carrier options and prices vary widely. Do your research.
- Make a realistic assessment of your health and financial needs. If you are in a high-cost-of-living area, you may need to compromise. Listen to your health insurance agent.
- Consider a high deductible Plan FHigh Deductible Plan F is a version of the regular Medigap Plan F. You pay all costs until spending reaches the annual, then the plan pays all Medicare-approved costs. or Plan G. The monthly premium on these plans is often $100 or more than the standard plan. If you put this amount into savings every month it only takes about two years to put away the amount of the high deductible.
- If you can’t decide between a Medicare Supplement and Medicare Advantage, go with Medicare Advantage for the first year. Give it a try. Use your trial right to switch back if you don’t like it. Your Medigap protections will be restored.
Are Medicare Supplement plans worth it? The only way to know for sure is to get quotes in your area. This will help you find the most affordable coverage.
Get a Free Medicare Supplement Rate Comparison
Can I Still Get Medigap Plan F?
No. That ship has sailed.
Medigap Plan CMedicare Supplement Plan C, also called Medigap Plan C, is one of the most comprehensive of the 10 standardized supplemental Medicare plans available in most states. In fact, only Medicare Plan F offers more coverage. and F are no longer available to individuals qualifying for Medicare today.
The plan with the most coverage that’s available to new Medicare beneficiaries is Medigap Plan GIf you're turning age 65 this year, Medicare Supplement Plan G is the most comprehensive Medicare supplement you can buy. It's also the most popular. You might be thinking that Medicare Supplement Plan F is....
Can I Get A Medicare SELECT Plan?
That all depends on where you live.
Medicare SELECTMedicare SELECT is a type of Medigap policy (Medicare supplement plan) that requires its members to get their primary care from a contracted provider. plans are supplemental Medicare policies that require you to use a contracted hospital for your inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition. and some outpatient services. The benefit of these plans is a lower premium.
Can I Get Medigap with ESRD?
People with end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) do not qualify for supplemental Medicare insurance. Medicare covers ESRD patients differently, so generally Medigap is not needed.
Recently, the Medicare program opened up Medicare Advantage plans to people with ESRD, so there is a second option.
Can I Get Medigap If I Have Medicaid?
No. And you don’t need to.
If you are dually eligible for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. you have better options than Medigap.
Under the Medicare Advantage program, you may have D-SNP Special Needs Plans available in your area. These plans coordinate your Medicare and Medicaid benefits into a single plan with minimal costs.
If a D-SNP plan is not available in your area, you may qualify for a Medicare Saving Program, such as the Qualified Medicare BeneficiaryA person who has health care insurance through the Medicare or Medicaid programs. (QMB) Program.
The QMB program assists with monthly premiums and coinsurance so there is very little cost-sharing. Social Security also has a program, known as Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium..., that assists with the cost of prescription medications.
Can I Get Medigap If I Have Medicare Advantage?
No. According to federal law, the two types of insurance are not compatible.
A Medigap policy only works with Medicare Part A and Part B. If you join a Medicare Advantage plan, the plan takes over providing your Part A and Part B benefits.
To get the same level of coverage in Medicare Advantage that you can get with a Medigap policy, you will need to pay higher premiums. Most Medicare Advantage plans have higher inpatient costs than Original Medicare alone. A plan with a higher premium may cover more of your Part A and Part B out-of-pocket costs.
What If I’m Turned Down?
Medicare Supplement insurance is not health insurance. So, unlike a Medicare Advantage plan, carriers have the right to turn you down if you no longer have Medigap protections.
Depending on your health status, some carriers will offer you a policy with a waiting period. If you don’t make a claim during the waiting period, your policy goes into full effect.
In other instances, a carrier might offer you a plan with less Medicare coverage, such as Medigap Plan AMedicare Supplement Plan A is often confused with Medicare Part A, which is the Medicare coverage that pays for your inpatient hospital care. Medicare Supplement Plan A, which is also known as Medigap Plan A,..., L, or K.
Medicare Supplement State Law Variations
A few states have implemented legislation that makes it easier to switch from one plan to another. Also, some states have made it easier for people under age 65 to get Medigap coverage.
In Connecticut and New York, Medicare supplements are guaranteed-issue all year long.
In Massachusetts, Medigap plans are guaranteed-issue to February through March.
California and Oregon have birthday rules that give enrollees a 30-day window following their birthday each year when they can switch Medigap plans without going through medical underwriting, but only if they are going to a plan with the same or lesser benefits.
In Maine, Medicare beneficiaries can switch to a different Medicare supplement plan with the same or lesser benefits at any time during the year. Also, all Medicare supplement carriers must designate one month each year when Plan A, the plan with the fewest benefits, is available guaranteed-issue to everyone that qualifies.
Missouri has an anniversary rule that allows anyone with Medigap coverage a 60-day window around their plan anniversary each year during which they can switch to the same plan, guaranteed issue, with another carrier.
If you are under 65 and eligible for Medicare due to a disability, Medicare supplement availability depends on the regulations in your state. There are no federal regulations or protections that guarantee Medigap enrollment for people under age 65.
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Citations and References
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medicare.gov
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When can I buy Medigap? | Medicare
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Welcome to Medicare | Medicare
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Welcome to Medicare | Medicare
kff.org-
Medigap Enrollment and Consumer Protections Vary Across States | KFF
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A Relatively Small Share of Medicare Beneficiaries Compared Plans During a Recent Open Enrollment Period | KFF
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Medicare Beneficiaries Rarely Change Their Coverage During Open Enrollment | KFF
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