If you are looking to sign up for a Medigap policy, it is important to be aware of Medicare’s annual enrollment period and the Medigap Open Enrollment period. But how are these different?
According to experts at Forbes, Medicare’s Annual Open Enrollment Period is a unique time of the year when seniors aged 65 and above can enroll in Medicare Advantage plan, switch MA plans or re-enroll in original Medicare; you can enroll or switch PDPs during this time, as well. If you re-enroll in Original Medicare, you may then apply for a Medicare Supplement; however, you may be subject to health underwriting. Alternatively, your OEP takes place when someone signs up for Medicare Part B and is 65 or older. Often called Medicare Supplemental Insurance, this policy pays for out-of-pocket costs that Original Medicare does not cover.
Medicare beneficiaries have the ability to enroll in Medigap at any time. However, those who choose to do so outside of the open enrollment period may be denied coverage or may be charged more with health underwriting.
But when exactly is the Open Enrollment Period? According to experts, under government guidelines, insurance companies are required to sell their Medigap policies at the lowest price or what is called a preferred rate. This a six-month period during which an insurance company cannot deny coverage when an individual meets several requirements, which include the following:
- Enrollment in Medicare Part B
- If one is aged 65 or above
The annual open enrollment period comes around once per year, from Oct 15 – Dec 7TH. There are special enrollment periods for those who are still working and still receiving insurance benefits through their employer.
You have the ability to make changes to your coverage outside of the annual enrollment period, should something happen that necessitates you to change your coverage based upon your situation. Sometimes coverage can be changed if you suffer a job loss and retire.
For your OEP, after the six-month window to sign up closes, your options for purchasing a Medigap policy become limited, and available policies may increase in price.
The Medicare Supplement Open Enrollment Period happens only once in your life. Because of this, it is by far the best time to sign up for a Medigap supplement policy. You can sign up for a Medigap policy at any time of the year, but it is only during the open enrollment period that you can sign up without insurance companies looking at your health history as a basis for giving you coverage.
If you apply outside of the open enrollment period, insurance companies have the right to deny you coverage based upon any preexisting health conditions you may have. You don’t have to answer any health questions if you apply for coverage during this OEP period. As a result, you are guaranteed coverage if you are eligible to receive it.
You should qualify for and receive coverage if you meet the criteria and are at least 65 and are enrolled in Part B when you apply for a Medigap policy. If you sign up for a policy outside of your open enrollment period, insurance companies are allowed to ask questions about your health to determine whether to grant or deny you coverage. Your answers to these questions will ultimately determine whether you get a Medigap policy.
According to experts, roughly 10,000 people turn 65 each day, and this marks a significant occasion for many seniors. Open enrollment is a specified period when those aged 65 and above can enroll in a number of different Medigap policies.
During Open Enrollment, you can apply or purchase any Medigap policy without having to deal with any medical underwriting, penalties or fees, or “denial of coverage.” There are key differences between the Annual Enrollment Period and Medigap Open Enrollment.
The Annual Open Enrollment Period pertains to people joining a MA-PD or MA plan for the first time, switching back to original Medicare, or joining/switching a PDP plan. This open enrollment period runs from October 15 to December 7th of each year.
According to Medigap experts, most people enroll in Medicare or a Medigap plan when they reach age 65. However, there are people who work until they are 65 or older. These individuals may not get Medicare part B at the age of 65 and consequently do not enroll until they are older and no longer have coverage under their employer.
When these individuals decide to retire and enroll in Medicare Part B, their open enrollment period starts after enrolling in Part B. You have 8 months after your employer coverage ends or you receive a notice to enroll in Part B. If you enroll in Part B at 65 while you are still employed, you’ll have a 63 day special enrollment period to join a Medigap plan without health underwriting.
Once seniors hit age 65, they are guaranteed coverage to a number of comprehensive Medigap plans, including Medigap Plan G and Plan F. Medigap Plan F is only available to seniors who are enrolled in Plan F prior to January 1, 2020. You can no longer enroll in Plan F for new Medicare enrollees after 2020, but those who already have it can continue to receive coverage.
If you know your Medicare number and have applied early for Medicare, you can apply before the date your Part B becomes active. During this time, your insurance company will process your application without asking you any questions about your health.
Some people choose to purchase a Medigap policy before the month that they turn 65. You do not need to wait until your sixty-fifth birthday to apply; however, your policy won’t become effective until your Part B start date. There is no difference in out-of-pocket costs applying for your Medigap policy prior to your part B effective date.
Can you purchase Medigap policies at other times of the year? You can apply for a Medigap policy at any time of the year. If you choose to do this, you will be required to answer questions about your health, and you may have to deal with medical underwriting. Unless you have protection under your one-time Open Enrollment window, your underwriter can deny you coverage.
Both of these policies are great. However, you should be aware of a few other things.
Guaranteed Issue Rights
Guaranteed issue rights “refer” to your right to purchase specific Medigap policies outside of your enrollment period for any number of reasons. You may be able to apply for and obtain Medigap coverage in certain situations, which include fixed rules. As an example, you switch back to Original Medicare after getting Medicare Advantage and you’ve been in your MA plan for less than a year.
Preexisting conditions
As mentioned earlier, preexisting conditions often play a role in your ability to obtain a Medigap policy. The way Medicare defines a preexisting condition is different from the way others may define a preexisting condition. Medicare defines a preexisting condition as a condition you have or had and received treatment for in the past.
However, there may be cases where a condition is considered preexisting, even if you have not yet received a diagnosis or if it has not been treated. Let’s look at an example. Someone who is age 65 with diabetes that requires glucose monitoring and insulin may be labeled as having a preexisting condition. Someone who uses a CPAP machine for sleep apnea may also be labeled as having a preexisting condition.
These are considered preexisting conditions, because you have received a diagnosis for a condition. Every state has its own rules for coverage. It is a good idea to look at your state’s rules for eligibility. This is especially important if you want to change coverage outside of open enrollment period.
Coverage may be difficult if you have a preexisting condition. An insurance company may look at your preexisting conditions to determine how much of a risk you are and how your condition would affect them financially. Underwriters realize that they stand to lose money if you have high medical expenses for preexisting conditions.
Because of this, they examine your health history to see how much of a risk you are. Let’s say that you had a brain hemorrhage and required costly surgery. Even if you have fully recovered from the injury, an insurer may see this as a problem and may deny you coverage. Conversely, an insurance company may offer coverage, but you may have a high monthly premium.
An insurance company will also examine your smoking status. According to research, 40 percent of Medigap applicants could be denied coverage due to having a preexisting condition. To minimize your chances of being denied coverage, it is a good idea to apply for a Medigap policy during the open enrollment period.
Otherwise, you may be left paying out-of-pocket for all costs that are not covered by Original Medicare.
8 Sources
MedigapCoverage has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.
https://www.ncoa.org/article/medigap-open-enrollment-period
https://www.prudential.com/financial-education/open-enrollment-vs-annual-enrollment.
https://www.forbes.com/health/medicare/medicare-supplement-open-enrollment/
https://www.uhc.com/medicare/medicare-education/medicare-supplement-plans.html
https://www.cms.gov/medicare/health-plans/medigap
https://www.nerdwallet.com/article/insurance/medicare/medigap-plan-g
https://www.mayoclinic.org/diseases-conditions/sleep-apnea/in-depth/cpap/art-20044164
https://www.nerdwallet.com/article/insurance/medicare/what-is-medicare-part-b