Medicare's fall Open Enrollment (October 15 to December 7) doesn't give you a federal right to switch Medigap policies. It's for changing Medicare Advantage and Medicare drug plans. You can apply for a different Medigap policy at any time of year, but Medicare.gov says that in most cases, outside your one-time Medigap Open Enrollment Period, an insurer can ask medical questions and may charge more or say no.
Why isn't fall Open Enrollment the time to switch Medigap?
The names are confusing. Medicare uses "Open Enrollment" for two different things.
The Medicare Open Enrollment Period runs October 15 to December 7 every year. Medicare.gov says you can use it to change how you get your coverage, like joining, switching, or dropping a Medicare Advantage Plan or a Medicare drug plan. Changes start January 1.
The Medigap Open Enrollment Period is a one-time, 6-month window. Medicare's Medigap booklet says it starts the first month you have Part B and you're 65 or older, and it doesn't repeat every year. During that window, an insurer can't refuse to sell you any Medigap policy it offers or charge you more because of health problems.
So if your Medigap window ended years ago, the fall season doesn't reopen it.
When do I have a federal right to switch?
Medicare's Medigap booklet says that in most cases, federal law doesn't give you a right to switch Medigap policies. There are two exceptions:
- You're still within your 6-month Medigap Open Enrollment Period.
- You have a guaranteed issue right because of a specific situation.
The booklet's chart lists these situations. Two of them apply to people who already have Medigap:
- Your Medigap company goes bankrupt and you lose your coverage, or your policy ends through no fault of your own.
- You drop your Medigap policy because the company didn't follow the rules or misled you.
In either case, you can buy Plan A, B, D or G from a company in your state. If you were eligible for Medicare before 2020, Plans C and F are options too. Don't wait. The booklet says to buy the new policy no more than 63 days after your old coverage ends.
If you're leaving a Medicare Advantage Plan, different rules apply. See leaving Medicare Advantage: can you still get Medigap?
Can I still apply even without that right?
Yes. Nothing stops you from applying. Medicare.gov says that if you switch outside your Medigap Open Enrollment Period, you may have to pay more and answer some medical questions. The insurer can use those answers to decide whether to sell you a policy.
Your state may also give you more chances to switch. Medicare.gov says to contact your State Insurance Department to find out if your state offers more opportunities to change your Medigap policy. Massachusetts, Minnesota and Wisconsin set up their Medigap policies differently and have their own rules.
Questions the booklet suggests asking the new insurer:
- "Do you use medical underwriting for this Medigap policy?"
- "Can you tell me if I'm likely to qualify?"
- "Do you have a waiting period for pre-existing conditions? If so, how long?"
How do I switch without a gap in coverage?
The booklet says not to cancel your old policy until you've decided to keep the new one. So apply to the new company first. If it accepts you, ask your current company to end your old policy after your first 30 days with the new one.
Those 30 days are your "free look period." It starts when you get the new policy, and it gives you time to decide whether to keep it. The booklet says you'll pay both premiums for the month you have both.
On the new application, you'll promise to cancel the old policy. But don't cancel it until you've decided to keep the new one. The booklet says that once you cancel your old policy, you can't get it back.
What to say to your current insurer, once the new policy is in place:
"I've been approved for a new Medigap policy that started on [date]. I'd like my current policy to end on [date, after the 30-day free look]. Can you confirm that date in writing? And if I've paid any premium for time after that date, how do you handle it?"
Will my new policy cover my health conditions right away?
It should, if you've had your current Medigap policy for more than 6 months. The booklet says that if the new policy has the same benefits, the new insurer can't exclude a pre-existing condition or make you wait.
There are two cases where you might wait up to 6 months:
- You've had your current policy less than 6 months. The new insurer must subtract the months you've had it.
- The new policy has a benefit your old one didn't. You may wait up to 6 months for that new benefit.