Medicare Supplement Open Enrollment Period
The Medigap Open Enrollment Period is unique to each person and happens only one time. It is aligned with the individual’s Initial Enrollment Period upon turning 65 (or reaching the point of replacing creditable coverage with Medicare).
From the date Medicare Part B becomes active (usually the first day of the 65th birthday month) to the last day of the sixth month afterward constitutes the Medigap Open Enrollment Period.
If you turn 65 in April, it will begin on April 1 and end on September 30.
How long is Open Enrollment for Medicare Supplement policies?
This one-time Open Enrollment Period lasts for precisely six months.
Buy a Medigap Policy When You’re First Eligible
Medicare offers extensive choices and can be quite confusing. During your Medigap Open Enrollment Period, you can choose any Medigap Insurance coverage available in your area regardless of your health status or pre-existing health problems. This is generally the best time to enroll since you can avoid medical underwriting and higher rates if you have any pre-existing health conditions.
New Medicare beneficiaries must begin by researching the various aspects of Medicare. It is advisable to locate and consult with a licensed insurance agent who can help you find the best possible insurance coverage for your needs and budget.
Original Medicare (Medicare Part A and Medicare Part B) covers 80% of Medicare-approved
charges, leaving 20% to be paid as cost-sharing, including:
- Coinsurance (Part A and Part B)
Original Medicare does not have a cap on cost sharing, so many people purchase Medicare Supplement insurance plans to help with the 20% cost sharing.
Enroll During your Medigap Open Enrollment Period
You purchase a Medigap plan from a private insurance company. The insurance company cannot legally refuse to sell you the Medicare Supplement policy of your choice or charge you a higher monthly premium than they would charge a healthier individual.
Unlike the Annual Election Period, which lasts from October 15 through December 7 each year, there is no repeat of the Medicare Supplement Open Enrollment Period except in uniquely special circumstances.
Medicare enrollees who fit into special circumstances are allowed a Guaranteed Enrollment Period according to the following specifications.
Find Your Situation:
I’m 65 or Older
Enrolling in Medicare Part B upon turning 65 is advisable for most people. However, if you decide to wait until a later date unless you have circumstances qualifying for Guaranteed Issue Rights, you might have to pay a penalty. This would mean paying a higher monthly premium for Part B for as long as you are enrolled in Medicare.
I’m Turning 65
The Medigap Open Enrollment Period begins the first day of the month you are 65 and are enrolled in Medicare Part B. It lasts for six months after the Part B effective date. For example, if you turn 65 in July and your Medicare Part B enrollment starts on July 1, your Medigap Open Enrollment Period would end on December 31. If you miss or skip this time frame, you may not be able to buy a Medigap plan, or it may cost you higher premiums.
Your monthly premium amounts depend partly on what type of Medigap plan you choose. Those who become eligible for Medicare coverage after January 1, 2020, can no longer choose Plans C or F. Those who became eligible before January 1, 2020, but delay due to Guaranteed Issue Rights may still enroll in Plan F. The two most popular plans available to new enrollees after January 1, 2020, are Plan G and Plan N.
Some people choose to enroll in a Medicare Select plan. These are more limited in the number of doctors and hospitals available. Your Medicare agent can help you learn more about Medicare Select plans in your service area. Medicare Select Plan G offers the same benefits as Plan G, but by limiting the number of providers and negotiating prices with them, it can offer lower monthly premiums.
I’m Under 65
Some people qualify for Medicare for the first time before age 65 if they have ALS (amyotrophic lateral sclerosis or Lou Gehrig’s Disease), ESRD (end-stage renal disease), or other serious health conditions.
Federal law does not require insurance companies to sell Medicare Supplement insurance to people under 65. However, some states mandate that insurance companies make at least one Medigap policy available to Medicare recipients under 65.
Many Medicare recipients eligible due to disabilities wait until they turn 65 to apply for a Medigap policy. A second Medigap Open Enrollment Period at 65 would offer them guaranteed coverage with all the other benefits described above.
I Have Group Health Coverage Through an Employer or Union
Suppose you or your spouse continue working beyond the month you turn 65 and continue to have employer- or union-based health care coverage. In that case, you may be able to postpone enrolling in Medicare Part B without incurring a penalty.
Your coverage may be comparable to a Medigap plan in helping cover the gaps left after Original Medicare (Part A and Part B) covers the 80%. However, since you do not need Medicare Part B yet, you may delay enrollment until your employer- or union-based insurance ends.
Should you sign up for Medicare Part B while still on employer- or union-based insurance and not enroll in a Medigap policy, you might miss your only opportunity to have a Medicare Supplement Open Enrollment Period.
Enroll Outside Medigap Open Enrollment Period
I have a pre-existing condition
When applying for a Medigap policy outside your Medigap Open Enrollment Period, you may be able to buy a policy for an acceptable price but still, have a waiting period for a pre-existing condition to be covered.
If you have had at least six months of creditable health care coverage with no more than a 63-day lapse, you may be able to avoid or shorten the waiting period for coverage of a pre-existing condition.
Examples of creditable coverage include:
- Employer group health plans
- Union-based health plans
- Department of Veterans Administration (VA) insurance
- Federal, state (Medicaid), or local government health plans
If you choose to delay enrolling in Medicare Part D (Prescription drug coverage), you will also need to have a creditable prescription drug insurance plan to avoid paying a penalty to enroll in Part D Medicare at a later date.
I have other health insurance
If you have creditable health insurance through a Union or an employer, your Medigap Open Enrollment Period begins when you enroll in Part B.
I have a guaranteed issue right
Purchasing a Medigap policy while you have Medigap protections, also known as Guaranteed Issue Rights, means that the insurance company cannot impose a waiting period for pre-existing conditions.
Can you enroll in a Medicare Supplement plan at any time?
Yes, you can enroll in a Medicare Supplement plan at any time of the year. However, your acceptance will not be guaranteed. The insurance company can legally refuse you coverage based on medical issues, or a higher monthly premium may be charged.
You might have to undergo Medical Underwriting and answer extensive questions about your health.
If you find yourself in this position and get rejected by a company you apply to, contact a licensed insurance agent to learn about different private insurance companies and plan options that might work for you.