During open enrollment, companies must sell you one of the required Medigap policies at the best price for your age, without a health screening (also known as medical underwriting). However, companies may impose a waiting period for pre-existing conditions.
Here, we’ve compiled the information you need to know about this important timeframe.
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If you are age 65 or over and eligible for Medicare, you have a 6-month period during which you can purchase any Medigap policy at the lowest price for your age, even if you have or recently had health problems.
Your 6-month open enrollment period starts the date your Medicare Part B coverage becomes effective. To avoid a gap in coverage, you can apply for a Medigap policy before the effective date of your Part B coverage and request that the policy begin on the same date as your Medicare benefits.
If you became eligible for Medicare when you were younger than age 65, you are also entitled to a 6-month open enrollment period on your 65th birthday, regardless of any health condition you have, including ESRD. If you already have a Medigap policy, you can keep it and request a lower premium because you are age 65, or you can switch to another Medigap policy that is better suited to your needs.
In California, if you were covered by an employer group health plan and you delayed enrollment in Medicare Part B because you or your spouse were actively employed, you also have a 6-month open enrollment period. This begins on the effective date of your Part B coverage.
Note: If you also delayed enrollment in Medicare Part D, you have only 63 days from the date your employer group benefits end to enroll in a prescription drug plan.
If you are younger than age 65 and have Medicare because of a disability (not End-Stage Renal Disease), you have open enrollment rights for 6 months after the effective date of your Medicare Part B coverage. If you are notified retroactively of your eligibility for Medicare, your open enrollment period begins from the date of the notice you receive from Social Security.
During the open enrollment period, you have the right to purchase Medigap plans:
- A, B, C or F, or
- K or L, or M or N at the option of the insurance company, if it sells these plans
To avoid a gap in coverage, you may request that the Medigap policy becomes effective on the same date as your Medicare benefits.
Note: Companies have no restrictions on premiums for people younger than age 65, so they can charge you a higher premium than someone who is age 65 or over.
In California, you also have the right to purchase a Medigap policy for 6 months following the 4 events below. Your choice of Medigap plans depends on your age. If you are age 65 or over, you can choose from all the Medigap plans available in your area. If you are younger than 65 (and you do not have End-Stage Renal Disease), you can only choose plans A, B, C or F. You may also be able to choose plans K or L or M or N, if they are available. The company has the right to choose which of these latter 4 plans it will sell you.
You have the right to purchase a Medigap policy for 6 months if your, your spouse’s or a family member’s current employment or retirement plan coverage terminates, or you lose your eligibility due to divorce or death of a spouse or family member. The 6-month period to apply for a Medigap policy starts on the date you receive notice that your health benefits will end. If you do not receive advance notice, the 6-month period starts the date the benefits end or the date of your first denied claim. This protection of California law applies whether your group health benefits were primary or secondary to Medicare.
Note: You are also entitled to this protection when you become eligible for COBRA or have used up all your COBRA benefits. It does not apply if you stop paying COBRA premiums before you use all your benefits. COBRA benefits are always secondary to Medicare benefits unless you have ESRD and are in a 30-month coordination period. For more information on COBRA, see Medicare & Other Health Insurance.
Moving Out of the Medigap Plan’s Service Area
You have the right to purchase a Medigap policy for 6 months if you move out of the area served by your Medigap plan. For example, if you bought a plan while living in another state that will not cover you in your current state, you have 6 months to replace that plan. If you don’t, you may be required to undergo a health screening.
Loss of Military Health Coverage
You have the right to purchase a Medigap policy for 6 months if your health care coverage ends because:
- A military base closes
- A military base no longer offers health care services
- You move away from a military base
- You lose access to health care services at a military base
Loss of Medi-Cal Benefits
You have the right to purchase a Medigap policy for 6 months when you lose your eligibility for full Medi-Cal benefits because of an increase in your income or assets.