Under California law, you have the right to purchase certain Medigap plans following 2 other events. Each has a different time limit in which to exercise your rights.
1. Medicare Advantage (MA) Plan Terminates Coverage in Your Area
You have the right to purchase Medigap plansA, B, C, F, K or L if your Medicare Advantage (MA) plan leaves your area. You can apply anytime after the MA plan notifies you, but in order to get a guaranteed-issue Medigap policy, you must apply within 123 days of the end of your MA plan benefits. In addition, you only have 63 days to replace prescription drug benefits (e.g., enroll in a Medicare Part D plan) if they were included in your MA plan benefits.
2. 30-Day Period Following Birthday
You have the right to purchase certain Medigap plans each year for the 30-day period following your birthday. You must have a current Medigap plan to exercise this right. You can choose a plan from any company, but you are limited to one that has the same or fewer benefits than your current plan. For example, if you already have Plan C, you may switch to another Plan C, but not to a Plan G.
If you have an old plan or one that is no longer sold (for example, plans E, H, I and J were dropped as of June 2010 and are no longer sold due to changes in federal law), you can choose as follows:
- Plans A, B, C, D, or F can all be replaced with the same lettered plan
- Plans E and H can be replaced with Plan D
- Plan I can be replaced with Plan G
- Plan J can be replaced with Plan F
- High deductible plans F and J can only be replaced with high deductible Plan F
Also, not all companies sell every kind of plan. If you're set on buying from a particular company, you can only choose from the types of policies they have available.
3. Changes to Medicare Advantage (MA) Plan
You have the right to purchase certain Medigap plans if your Medicare Advantage (MA) plan increases or adds additional copayments, reduces your benefits or a medical provider treating you leaves the plan. In these situations, you can only buy a Medigap plan from the company that offers your MA plan, its parent company or a network that contracts with the MA plan.
You can only exercise this right if the changes described above occur during the times you are permitted to disenroll from your MA plan:
- Annual Election Period (AEP): November 15 to December 31 of each year with an effective disenrollment date of January 1 the following year.
- MA Annual Disenrollment Period (ADP): January 1 to February 14 of each year with an effective disenrollment date of the first day of the month following your request.
If your MA plan increases your cost-sharing or reduces benefits (which usually occurs at the end of the plan year and coincides with the federal AEP), the plan is required to send you notice. A provider may leave or be dropped from your MA plan anytime during the year.
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