Medicare Advantage Plan Ending? You May Have a Protected Right to Buy Medigap

If your Medicare Advantage plan is ending, the notice may give you more than a reason to shop: you may have a protected right to buy Medigap when you return to Original Medicare. In a qualifying situation, an insurer cannot use your health history to reject your application for the policies covered by that protection.

Medigap is private supplemental insurance that helps pay certain costs left to you under Original Medicare, such as deductibles or coinsurance. Medical underwriting is the health screening an insurer may otherwise use when deciding whether to sell a policy or what to charge.

That distinction can be especially valuable to someone who has developed health problems since first becoming eligible for Medicare. The right depends on the event ending the coverage and the applicable federal and state rules.

First establish what is actually ending

Medicare.gov identifies qualifying circumstances that include an Advantage plan leaving Medicare or no longer covering the area where a member lives. A return to Original Medicare in such a situation can create guaranteed-issue rights for specified Medigap policies sold in the state.

Three other changes call for a different analysis. A doctor can leave a plan’s network while the plan continues. A premium can rise without terminating coverage. A member can voluntarily decide to switch even though the existing plan remains available.

Those changes do not by themselves establish the same federal purchase protection as a qualifying plan termination. State law may provide additional opportunities, and other federal protections can apply, including certain trial rights. Identify the actual event before assuming the application is protected.

The plan-ending letter is important evidence. Keep it, including the effective date and explanation, rather than relying on a broker’s description or a marketing mailing about alternatives.

Your protected application window: 60 days before to 63 days after

For the qualifying Advantage-plan loss described in Medicare’s guidance, the Medigap application window begins 60 days before coverage ends and extends no more than 63 days afterward. Applying before the old coverage ends can help coordinate the new policy with the return to Original Medicare.

This is separate from Medicare’s October 15-December 7 annual enrollment season. That fall window allows changes to health and drug coverage; it does not reopen everyone’s initial Medigap purchase period.

The usual initial Medigap window lasts six months, starting with the first month a person is at least 65 and enrolled in Part B. Outside that period or another protected situation, an insurer may be allowed to use underwriting.

Protection does not make every policy identical

Guaranteed issue means a protected opportunity to purchase eligible coverage, not free supplemental insurance or a promise that every plan design is available. Confirm the specific policies covered by your right with a counselor or the state insurance department.

Your original Medicare eligibility date also matters. People new to Medicare on or after January 1, 2020 cannot buy Plans C or F, which cover the Part B deductible; Medicare’s guide explains the availability of Plans D and G instead under relevant protections.

Federal law generally does not require Medigap insurers to sell to people under 65. States can offer additional rights for people eligible through disability or end-stage renal disease. State rules also matter in places with different standardization systems, including Massachusetts, Minnesota and Wisconsin.

Compare the replacement as a whole

Compare premiums for the same standardized plan across insurers. In most states, policies with the same letter offer the same basic benefits, but the price can differ. Ask how the premium is set and how it may change, as well as what you will pay at enrollment.

Medigap works with Original Medicare; it cannot be used to cover Medicare Advantage copayments. A new Medigap policy also does not supply prescription drug coverage, so account for a separate Part D plan when comparing the total arrangement.

Before applying, gather your Medicare card, plan-ending notice, coverage-end date and quotes. Ask the insurer which guaranteed-issue provision applies and when the Medigap policy would start.

Make sure the dates line up: Advantage coverage ends, Original Medicare resumes, Medigap begins and separate drug coverage starts. A State Health Insurance Assistance Program counselor or 1-800-MEDICARE can help check the transition.

References: When can I buy a Medigap policy? | Get ready to buy | Buying a Medigap policy | Medicare supplement insurance guide | Choosing a Medigap Policy - Large Print Edition