Seven (7) situations that give you the right to purchase a Medigap Policy

This is valuable information for you to know, starting this new year!

We are starting this new year with some facts that you should know. According to Federal law, there are 7 common situations that give you the right to buy Medigap policies A, B, C, D, F, G, K or L  that are sold in your state by any insurance company. As a reminder, Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy Plan C or Plan F. People new to Medicare on or after January 1, 2020, have the right to buy Plans D and G instead of Plans C and F.

Here are seven (7) common situations that give you the right to buy a Medigap Policy:

1.      Your Medicare Advantage Plan is no longer with Medicare.

Because your plan is leaving Medicare, stops giving care in your area or if you have moved out of the plan’s service area, you have the right to purchase one of the Medigap policies highlighted above. To purchase a Medigap policy, you must switch to Original Medicare—you can’t switch to another Medicare Advantage plan. This change also must be done as early as 60 calendar days before the date your Medicare Advantage Plan coverage will end, but no later than 63 calendar days after your coverage ends. Medigap coverage can start once your Medicare Advantage Plan coverage ends. You can’t have Medigap Insurance and Medicare Advantage Plan coverage at the same time.

2.      Your employer group health plan is ending.

The employer group health plan can include retiree, COBRA, or union coverage. If you have Original Medicare and your employer group health plan is ending and pays after Medicare, you are eligible to purchase a Medigap policy listed above. Keep in mind, you may also have rights under state law.

COBRA coverage – if you have this coverage, you can purchase a Medigap policy immediately or wait until your COBRA coverage ends but no later than 63 calendar days after the latest of the following: 

• Date coverage ends.

• Date on notice showing the coverage is ending.

• Date on a claim denial showing your coverage is ending, particularly if this is the only way you knew about your coverage ending

3.      You have a Medicare SELECT Policy and Original Medicare. 

If you move out of the Medicare SELECT policy’s service area, you can purchase one of the Medigap Policies sold in your state or in another state (that you are moving to). You also may have additional rights under state law. You must make this change as early as 60 calendar days before the date your Medicare SELECT coverage will end, but no later than 63 calendar days after your Medicare SELECT coverage actually ends.

4.      You joined a Medicare Advantage Plan or Program of All-inclusive Care for the Elderly (PACE).

If you joined one of these plans when you were first eligible for Medicare Part A at 65, and you decide that you want to switch to Original Medicare within the first year of joining, you can purchase any Medigap policy in your state by any insurance company. This is called a Trail right. You must do this as early as 60 calendar days before the date your coverage will end but no later than 63 calendar days after your coverage ends. Please note your rights may last for an extra 12 months under certain circumstances.

5.      You decided to cancel the Medigap policy to join a Medicare Advantage Plan  or Medicare SELECT plan.

If this was a first-time decision and you have been in one of these plans for less than a year, you can switch back to the Medigap Plan if the following applies (This is also called a Trial right.):

• You switch back to the same Medigap plan with the same insurance company you had before. But if the Medigap plan is no longer available, you can select any Medigap plan listed above with any insurance company in your state.

6.      Your Medigap Insurance company goes bankrupt, you lose your coverage or your Medigap Policy ends through no fault of yours.

No later than 63 calendar days from the date your coverage ends, you can purchase one of the Medigap policies highlighted above and sold in your state by any insurance company.

7.      You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed rules or has misled you.

No later than 63 calendar days from the date your coverage ends, you can purchase a Medigap policy highlighted above and that is sold in your state by any insurance company.

Additional points to keep in mind:

• If you lose your health insurance coverage, you still have the guaranteed right to buy a Medigap policy. Just remember to keep all documents, such as letters, notices emails and/or claim denials, as proof to show that your coverage has been terminated. You should also keep the postmarked envelopes as proof to show when the documents were mailed. When you submit your Medigap application for coverage, make sure you include these documents to support your right to purchase Medigap policy.

• If you have a Medicare Advantage Plan and you are planning to return to Original Medicare, you can apply for a Medigap Policy before your Medicare Advantage Plan ends. Make sure your new Medigap Policy begins after your Medicare Advantage Plan ends to ensure continuous coverage.

• All the information in this post is based on Federal law. State laws may provide additional Medigap Rights. For additional information, select the following links: State Health Insurance Assistance Program or State Insurance Departments, or refer to pages 48 and 49 from the 2023 Choosing a Medigap Policy:  A Guide to Health Insurance for People with Medicare . The information from this Guide is reflected throughout this post.

• We also spoke about PACE in this post. This program combines medical, social, and long-term care services, and prescription drug coverage for frail older adults who need nursing home services but are capable of living in the community. To be eligible for PACE, you must meet certain conditions. To learn more about PACE, refer to these links:  CMS and PACE and Medicaid and PACE.

We covered a lot in this post. We hope this information is helpful. If you are interested in learning more about our Medigap Plans, Life Insurance and/or our ancillary plans, please contact us.

"Those people who develop the ability to continuously acquire new and better forms of knowledge that they can apply to their work and to their lives will be the movers and shakers in our society for the indefinite future." ~ Brian Tracy

Resources:

• 2023 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare