Thời điểm mua
• Thời điểm tốt nhất để mua một hợp đồng Medigap là trong Thời gian Ghi danh Mở cho Medigap. Thời hạn 6 tháng này bắt đầu từ tháng đầu tiên quý vị có Medicare Phần B (Bảo Hiểm Y Tế), và quý vị từ 65 tuổi trở lên. (Một số tiểu bang có thêm Thời gian Ghi danh Mở.)
• Nếu quý vị trì hoãn việc ghi danh vào Phần B vì quý vị đã có bảo hiểm sức khỏe theo nhóm dựa vào việc làm hiện tại của quý vị (hoặc vợ/chồng của quý vị), thì Thời gian Ghi danh Mở cho Medigap của quý vị sẽ không bắt đầu cho đến khi quý vị đăng ký Phần B.
Sau thời gian ghi danh này, quý vị có thể sẽ không mua được Medigap. Nếu quý vị vẫn có thể mua được Medigap, thì nó có thể đắt hơn.
Is There an Open Enrollment Period for Medicare Supplement Plans?
Your Medicare Supplement Open Enrollment begins the 1st day of the month your Medicare Part B becomes effective. This six-month enrollment period grants you guaranteed issue rights for any Medigap plan you wish to enroll in. However, many carriers allow you to enroll in a Medicare Supplement plan up to six months before your Medicare Part B start date.
A Medicare Supplement plan is essential for Medicare enrollees who wish to pay as few out-of-pocket costs as possible for their healthcare coverage. Medicare Supplement plans cover the costs that Medicare Part A and Part B leave behind, eliminating the high expenses associated with Medicare coverage.
Enrolling in Medigap during a guaranteed-issue period is essential. Especially if you have pre-existing conditions that could result in denial of your policy in the future.
If you miss your Medicare Supplement Open Enrollment Period, you can still apply for Medigap coverage throughout the year. However, there is a chance the application can be denied due to underwriting.
Be aware that Medigap plans in most states are only guaranteed issue during the six-month window that starts the month you turn 65 (or when you enroll in Medicare Part B, which might be after you turn 65 if you still had employer-sponsored coverage), and during limited special enrollment periods. There’s no annual open enrollment period like there is for Medicare Advantage, Medicare D, and Original Medicare.
If you don’t enroll during your initial enrollment period, you may have to pay a higher premium – or be declined altogether – if you’re in poor health, as carriers are allowed to use medical underwriting after your initial enrollment period has passed.
If you join a Medicare Advantage plan at age 65 and change your mind within 12 months of signing up (trial right), you will get your guaranteed issue rights back, but you must buy your Medigap policy no later than 63 calendar days after your Medicare Advantage coverage ends.2
Medigap protections cited above are mandated by federal law. However, states have the ability to add additional protection if they so choose. These states have specific rules:3
California – The birthday rule in California allows you to change policies within a 60-day window. The birthday rule begins 30 days before your birthday and ends 30 days after. Residents can switch to a policy with the same or less coverage.
Connecticut – Guaranteed issue year-round. Residents can make changes to their Medigap policy at any time.
Maine – Residents have an extension on the standard Medicare Advantage “trial right” rule. In Maine, you can “try” a Medicare Advantage plan for up to three years. You have 90 days after dropping the policy to buy a Medigap policy with guaranteed issue rights.
Missouri – If you have a Medigap policy, you can switch plans within 60 days of your enrollment anniversary.
New York – Resident may enroll in a Medigap plan without underwriting throughout the year.
Oregon – The birthday rule applies in Oregon.
Vermont – Residents can enroll in a Medigap plan without underwriting throughout the year.
Washington – Allows residents to switch Medigap plans (except for Plan A) at any time.
KEY TAKEAWAYS
Medical underwriting
But after that window ends, Medigap insurers in most states can use medical underwriting to determine your premiums and eligibility for coverage. (
and Washington
have rules making it easier for people to enroll or switch to a new Medigap plan after the initial enrollment period ends. There are also limited federal guaranteed-issue rights for Medigap plans.)
Medigap Protections
Since the Medicare program’s beginning in 1965, beneficiaries have had the right to buy Medigap insurance regardless of their health situation. And, once a policy is in place, carriers cannot cancel or increase premiums due to the beneficiary’s health condition. However, a beneficiary’s guaranteed issue right is a very narrow window of time; just 6 short months.
You may also be given Medigap protections if you are in a Medicare Advantage plan and move out of the plan’s service area. However, the law only allows you to buy Medigap Plan A, B, C, D, F, G, K, or L. Medicare Supplement Plan N, which is becoming very popular, and M are not included in this protection.2
