Your Right To Buy A Medicare Supplement Policy In Certain Situations
You have the right to buy the Medicare Supplement plan of your choice during your
medicare supplement open enrollment period. Your medicare supplement open enrollment period lasts
for six months. It starts on the first day of the month in which you are
both age 65 or older and enrolled in Medicare Part B. Once
you enroll in Medicare Part B, the six months medicare supplement open enrollment
period starts and cannot be changed. During this open enrollment period,
an insurance company cannot deny you insurance coverage, place conditions
on a policy (like making you wait for coverage to start), or change the
price of a policy because of past or present health problems.
If you apply for a medicare supplement plan after your medicare supplement open enrollment
period has ended, the medicare supplement insurance company is allowed to use medical
underwriting to decide whether to accept your application, and how much to
charge you for the policy.
There are a few situations involving health care coverage changes where
you may have the right to get a medicare supplement policy after your medicare supplement open
enrollment period has ended. In these situations, the insurance company
cannot deny you insurance coverage, place conditions on the policy (like
making you wait for coverage to start), or change the price of a policy
because of past or present health problems.
If you lose certain types of health care coverage, you have the right
to buy a medicare supplement policy outside of your medicare supplement open enrollment period.
These rights are called "Medigap Protections." They are also called
"guaranteed issue" rights because the law says that insurance companies
must issue you a policy.
Medigap protections are important because without them, if you do not
buy a medicare supplement policy during your medicare supplement open enrollment period, an
insurance company can refuse to sell you a policy, or you may be charged
more for the policy. In addition, if you drop your medicare supplement policy, you may
not be able to get it back except in very limited circumstances.
You should not wait until your health coverage has almost ended before
you apply for a medicare supplement policy. You can apply for a medicare supplement policy early
(while you are still in your health plan) and choose to start your medicare supplement
coverage the day after your health plan coverage ends. This will prevent
gaps in your health coverage.
Summary of Medigap Protections
There are a few situations
involving health coverage changes where you may have a guaranteed issue
right to buy a medicare supplement policy.
1. Your Medicare managed care plan, Private Fee-for-Service plan, PACE
provider, or Medicare managed care demonstration project coverage ends
because the plan is leaving the Medicare program or stops giving care in
your area, or
2. Your health coverage ends because of reasons other than a plan
leaving the Medicare program, or
3. You dropped your medicare supplement policy to join a Medicare managed care
plan, Private Fee-for-Service plan, or PACE program and then leave the
plan within one year after joining. Or you buy a Medicare SELECT policy
for the first time and drop the policy within one year after buying,
4. You joined a Medicare health plan (like a Medicare managed care plan
with a Medicare + Choice contract, or Private Fee-for-Service plan) or
PACE program when you first became eligible for Medicare at age 65 and you
leave the plan within one year of joining, or
5. A change in your circumstances gives you the right to leave
(disenroll from) your plan.
In order to get these medicare supplement protections, you must meet certain
conditions. All rights to buy medicare supplement policies under the following
situations include Medicare SELECT policies since they are a type of
medicare supplement policy. For more detailed on your rights and protections, you may
want to read Medigap
Policies and Procedures.
The medicare supplement protections in this section are from federal law. Many
states provide more medicare supplement protections than federal law. Call your State Health Insurance
Assistance Program or State Insurance Department for more
If you live in Massachusetts,
you have the right to buy a medicare supplement policy that is similar to the
standardized policies you have a right to buy in other states.
Note: There may be times when more than one of these situations
applies to you. When this happens, you can choose the protection that
gives you the best choice of policies.
If both situations #1 and #4 apply to you, you may have the right to
buy any medicare supplement policy.
- Situation #1 limits your choices to only medicare supplement plans A, B, C, or F
that are sold in your state.
- Situation #4 offers you the best choice by allowing you to buy
any medicare supplement policy that is sold in your state.