Medicare supplement Plans (Medigap) help pay for healthcare costs that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles. These standardized insurance plans are identified by letters and sold by private insurance companies nationwide.
You can buy a Medicare supplement during your one-time open enrollment period, which begins the month you turn 65 and enroll in Medicare Part B. During this six-month window, insurance companies are required to sell you a plan without looking at your health history. Find out more at Wisconsin Medicare Part D Plans.
Open Enrollment
Most types of health insurance, including employer-sponsored and marketplace coverage, have an open enrollment period that happens every year in the fall, allowing individuals to enroll or change their coverage. Some people may also be eligible for a special enrollment period depending on their circumstances, such as moving or having a qualifying life event like marriage or a job loss.
Open enrollment for Medicare Advantage and Part D plans (prescription drug coverage) is held each year from October 15 through December 7. This annual enrollment period is also called the Medicare Annual Election Period.
During this six-month open enrollment period, you can switch from one Medicare Advantage plan to another or from original Medicare to a Medicare Supplement (Medigap) policy without the need for medical underwriting. If you try to buy a Medigap policy outside of this period, the insurer can deny your application or charge more for coverage based on your age, health status and where you live.
Guaranteed Issue
Guaranteed issue rights allow individuals to enroll in a Medicare supplement plan without the need for medical underwriting. These rights typically arise in specific situations such as when a person loses certain health coverage.
In addition to protecting individuals from being denied coverage or charged more based on their current health, guaranteed issue rights can also help prevent the need to switch to different Medicare plans. This may help to reduce stress and financial burdens.
States have the flexibility to establish guaranteed issue protections that go beyond federal minimums. As a result, 28 states now offer state-specific guaranteed issue rights alongside federal protections. These states include California, Colorado, Illinois, Kansas, Maine, Montana, Oregon, Tennessee, Texas, Utah, and Wisconsin. State guaranteed issue protections can work well in conjunction with SEPs to provide a comprehensive safety net for individuals. However, it is important to understand when to apply to obtain these benefits. This is because they only last for a limited time.
Pre-Existing Condition Waiting Period
While Original Medicare (Medicare Parts A and B) can’t impose waiting periods on pre-existing conditions, some Medicare supplement insurance policies can. The length of the wait period depends on how long you had creditable coverage for a particular health condition before applying for a Medicare supplement policy and can be up to six months.
Medigap plans are sold by private insurance companies and are designed to cover some of the gaps in medical expenses left behind by Original Medicare. These policies can be purchased during an open enrollment period or during a special enrollment period after a qualifying event such as a move, loss of employment, or when your current plan’s terms end.
The federal law says that a Medicare supplement insurance company can’t impose a waiting period for your pre-existing health conditions if you have had creditable coverage for the previous six months. This can include individual health insurance, group health insurance from your employer, or TRICARE.
Exclusions
Although the ACA protects people with pre-existing health conditions, Medicare supplement plans are carved out of these protections. That means insurers can use medical underwriting to make judgments about who will receive coverage, and what coverage they will get.
That doesn’t mean you can’t switch Medicare supplement plans. You can do so during the Medigap Open Enrollment Period that begins the first month you have Medicare Part B and are age 65, or during a Special Enrollment Period triggered by certain life events like losing coverage.
But remember, all companies selling a given plan must offer the same core benefits — which are labeled A through L. So if you lose your current plan, or move out of its service area, you have a guaranteed issue right to purchase any Medicare supplement policy sold in your new location. The guarantee lasts for 63 days from the date your current coverage ends or the date you receive notice that it will end, whichever comes later.
