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A: Yes. The best time to enroll is during your Medigap open enrollment period, a six-month window of time that begins on the first day of the month that you are at least 65 years old and are enrolled in Medicare Part B.
During this period, a private insurance company that offers Medigap coverage can not:
Even if you enroll during your initial enrollment period, a private Medigap insurer may refuse (for up to six months) to pay your out-of-pocket expenses if you have a pre-existing health issue. If your pre-existing condition was diagnosed or treated within six months prior to the date your Medigap supplemental coverage was to begin, the insurance company can make you wait six months before covering your out-of-pocket expenses.
But if you had creditable coverage before enrolling in Medigap, without a gap in coverage of more than 63 days, the pre-existing condition waiting period will be reduced by the number of months that you had creditable coverage. So if you had continuous coverage for six or more months before enrolling in Medigap, you won’t have a pre-existing condition waiting period. The rules can be confusing, so don’t hesitate to talk to a representative of the Medigap insurance company for clarification.
After your six-month open enrollment window, Medigap plans are medically underwritten in nearly every state, meaning that if you apply for coverage outside of your open enrollment window, you can be declined or charged more based on your medical history.
There are also some limited special enrollment periods for Medigap coverage, including
You can certainly apply for a new Medigap plan during the annual Medicare open enrollment period (October 15 to December 7), but that’s no different from any other time of the year.
The annual Medicare open enrollment period (annual election period) is for Medicare Advantage and Part D plans, but it doesn’t change anything about the normal enrollment rules for Medigap. In most states, if your initial enrollment window has ended, Medigap insurers are going to use medical underwriting if you submit an application for a new plan, regardless of what time of year you apply.
So for example, if you want to use the annual open enrollment period to switch from Medicare Advantage to Original Medicare, you can do that. And you’ll be able to enroll in a stand-alone Part D plan to supplement your Original Medicare. You’ll be able to apply for a Medigap plan as well, but in most states, the coverage will not be guaranteed issue — your eligibility will depend on your medical history.
The same will be true if you want to try to switch from one Medigap plan to another. Let’s say you have Original Medicare plus a Part D plan and Medigap plan, and you want to make changes to your coverage. You can switch to any available Part D plan during the annual open enrollment period, and your medical history will not be a factor. But in most states, your medical history will be a factor if you submit an application for a different Medigap plan.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.