How do I enroll in a Medigap plan?
Enrolling in a Medigap (Medicare Supplement Insurance) plan is a straightforward process, but there are key steps and timing considerations to ensure you get the best coverage at the best price. Medigap policies help cover the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t cover, such as deductibles, copayments, and coinsurance. Here's a step-by-step guide on how to enroll in a Medigap plan:
1. Ensure You’re Enrolled in Medicare Part A and Part B
Before you can purchase a Medigap plan, you must be enrolled in both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). If you’re not already enrolled, follow these steps:
Apply for Medicare through the Social Security Administration if you’re approaching your 65th birthday or if you qualify based on disability.
Once you’re enrolled in Medicare, you’ll receive your Medicare card with details about your Part A and Part B coverage.
2. Determine When to Enroll: Medigap Open Enrollment Period
The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period (OEP), which gives you access to the best options without medical underwriting:
Your Medigap Open Enrollment Period starts the first month that you are both:
65 or older, and
Enrolled in Medicare Part B.
The Open Enrollment Period lasts for six months. During this time, insurance companies:
Cannot deny you coverage due to pre-existing health conditions.
Cannot charge higher premiums based on your health history.
If you miss this enrollment period, you may still be able to purchase a Medigap plan, but the insurer can consider your health status and may charge higher premiums or deny coverage based on medical underwriting.
3. Compare Medigap Plans
Medigap policies are standardized and labeled with letters (e.g., Plan A, Plan B, Plan G, Plan N). Each lettered plan offers the same coverage across all insurance companies, but premiums can vary. Key steps include:
Review what each Medigap plan covers. For example:
Plan G covers almost all out-of-pocket costs except the Part B deductible.
Plan N has lower premiums but may require copayments for some doctor visits.
Consider your healthcare needs and budget. If you expect frequent doctor visits or medical services, a more comprehensive plan like Plan G might be a better option.
Use the Medicare Plan Finder Tool or compare plans on insurance company websites to find available options in your state.
4. Contact Insurance Companies to Get Quotes
Medigap plans are sold by private insurance companies, and premiums can vary from one company to another even for the same plan. To find the best price:
Contact different insurers for premium quotes.
Ensure that the insurance company is licensed to sell Medigap policies in your state.
Check if the plan includes any discounts (for non-smokers, couples, or those who pay annually).
5. Complete Your Medigap Application
Once you’ve chosen a plan and insurance company, you’ll need to complete the Medigap application. You can typically apply:
Online through the insurance company’s website.
By calling the company and applying over the phone.
By submitting a paper application via mail.
The application will ask for your:
Medicare number (found on your Medicare card).
Part A and Part B coverage start dates.
Personal information, including contact details and any preferences for premium payments.
6. Consider State-Specific Medigap Rules
Some states have their own Medigap rules that may offer additional protections or options:
States like Massachusetts, Minnesota, and Wisconsin offer Medigap plans that differ slightly from the standard federal options.
Some states have Medigap enrollment periods for individuals under 65 who qualify for Medicare due to a disability. If this applies to you, check your state’s rules to see what plans are available.
7. Know Your Rights: 30-Day Free Look Period
After purchasing a Medigap policy, you have the right to a 30-day “free look” period. During this time:
You can review the plan and decide if it meets your needs.
If you change your mind, you can cancel the policy within 30 days and receive a refund for any premiums paid.
8. Paying for Your Medigap Policy
Medigap premiums are separate from your Medicare Part B premium and must be paid directly to the insurance company. You may have the option to pay:
Monthly, quarterly, or annually.
Make sure you understand the premium payment options and due dates to avoid any lapse in coverage.
9. Switching Medigap Plans
If you already have a Medigap policy and want to switch plans, it’s important to know that:
You may not be able to switch plans without medical underwriting, unless you qualify for a guaranteed issue right (such as losing other health coverage or moving out of a Medicare Advantage plan’s service area).
If you’re still within your initial Medigap Open Enrollment Period, you can switch plans without medical underwriting.
10. Canceling Medicare Advantage to Enroll in Medigap
If you have a Medicare Advantage (Part C) plan but wish to switch to Original Medicare and enroll in a Medigap plan:
You’ll need to disenroll from Medicare Advantage during the appropriate Medicare Advantage Disenrollment Period or Open Enrollment Period.
Once disenrolled, you can apply for a Medigap policy to supplement your Original Medicare coverage.
Key Takeaways:
To enroll in a Medigap plan, you must be enrolled in both Medicare Part A and Part B.
The best time to enroll is during your six-month Medigap Open Enrollment Period, when you can get the best rates without medical underwriting.
Compare plans and premiums from multiple insurance companies to find the best option for your healthcare needs and budget.
You can apply online, over the phone, or by mail through a licensed insurance company.
For personalized assistance with enrolling in a Medigap plan or comparing your options, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
