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Unpacking Medicare Supplement: Part 4


unpacking medicare supplement, part four

With every story, there comes a point when it should naturally conclude. It reaches a place where both protagonist and reader are plenty satisfied, while the need for continuing appears to be nonexistent. One may believe this to be the case for Medigap Maggie's saga of discovery. However, one would be incorrect. Though nearly 65-year-old Maggie successfully acquired Medicare and Medicare Supplement a.k.a. Medigap coverage, there is still additional information that might aid our happy heroine as well as yourself.

The first notable item is Guaranteed Issue Rights. The website Medicare.gov, which has been our primary source for this series, illustrates what they are.

Guaranteed issue rights are rights you have in certain situations when insurance companies must offer you certain Medicare Supplement/Medigap policies. In these situations, an insurance company must:

  • Sell you a Medicare Supplement/Medigap policy
  • Cover all your pre-existing health conditions
  • Not charge you more for a Medicare Supplement/Medigap policy regardless of past or present health problems

In most situations, Medicare.gov indicates, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health coverage. Under other circumstances, you have a "trial right" to try a Medicare Advantage Plan and can still buy a Medigap policy if you change your mind.

The document "Choosing a Medigap Policy" contains a chart with the most common situations that would give you the right to purchase a policy, the kind of policy you can buy, and when you can or must apply for it. There are several scenarios included, but within this article, we will provide two of them.

Situation #1

You have a guaranteed issue right if you have a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area. Then, you have the right to buy Medigap Plan A, B, C*, D*, F*, G*, K, or I that is sold in your state by any insurance company. You only have this right if you to switch to Original Medicare rather than join another Medicare Advantage Plan.

You can/must apply for a Medigap policy as early as 60 calendar days before the date your Medicare Advantage Plan coverage will end, but no later than 63 calendar days after your coverage ends. Medigap coverage cannot start until your Medicare Advantage Plan coverage ends.

Situation #2

You have a guaranteed issue right if your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own. Then, you have the right to buy Medigap Plan A, B, C*, D*, F*, G*, K, or L that is sold in your state by any insurance company. You can/must apply for a Medigap policy no later than 63 calendar days from the date your coverage ends.

Note: Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy Plan C or Plan F. People new to Medicare on or after January 1, 2020, have the right to buy Plans D and G instead of Plans C and F.

Additionally, you may have a guaranteed Issue right to buy a Medigap policy if you lose your health coverage, so it is imperative to keep these documents:

  • A copy of any letters, notices, emails, and/or claim denials that have your name on them as proof of your coverage being terminated.
  • The postmarked envelope these papers come in as proof of when it was mailed.

You may also need to send a copy of some or all these papers with your Medigap application to prove you have a guaranteed issue right.

There is also the concern of what to do if you already have a Medigap policy in place, along with other questions that may arise.

Can I switch to a different Medigap policy?

In most cases, according to Medicare.gov, you will not have a right under federal law to switch Medigap policies, unless you are within your 6-month Medigap Open Enrollment Period or are eligible under a specific circumstance for guaranteed issue rights.

Do I have to switch Medigap policies if I have a Medigap policy that's no longer sold?

No. But you cannot have more than one Medigap policy, so if you buy a new Medigap policy, you must give up your old policy (except for your 30-day "free look period" described in the "Choosing a Medigap Policy" document). Once you cancel the old policy, you cannot get it back.

Do I have to wait a certain length of time after I buy my Medigap policy before I can switch to a different Medigap policy?

No. But if you have had your current Medigap policy for less than 6 months, the insurance company offering the new Medigap policy might make you wait up to 6 months before it covers a pre-existing condition.

Why would I want to switch to a different Medigap policy?

Some reasons for switching might include:

  • You are paying for benefits you do not need.
  • You need more benefits than you needed before.
  • Your current Medigap policy has the right benefits, but you want to change your insurance company.
  • Your current Medigap policy has the right benefits, but you want to find a policy that is less expensive.

Can I keep my current Medigap policy (or Medicare SELECT policy) or switch to a different Medigap policy if I move out-of-state?

In general, you can keep your current Medigap policy regardless of where you live provided you still have Original Medicare. If you want to switch to a different Medigap policy, you will have to check with your current or new insurance company to see if they will offer you a different Medigap policy.

The answers to the above questions have been abridged for this article. Please refer to the original Medicare.gov source for complete details, more explanation, and other questions.

Furthermore, there may be Medigap policies available for people with a disability or End-Stage Renal Disease (ESRD).

You may have Medicare before turning 65 due to a disability or End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

If you are under 65 and have Medicare because of a disability or ESRD, you might not be able to purchase the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally does not require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you are under 65. Please consult the complete list of states in the original Medicare.gov document.

The ultimate purpose of this blog series has been to inform as well as engage through reliable resources and Maggie's learning journey. Medicare Supplement combined with the details surrounding healthcare in post-retirement is a sizeable subject that can occasionally look nebulous. Ideally, these articles have transformed the topic into something more defined and approachable.

Of course, with that all stated, our protagonist still requires a proper send-off.

Having more than earned a break from managing her health matters, Maggie leaves the dining room table that almost became a student’s desk. She shakes her husband out of his near-catatonic state in front of the living room’s blaring television. Setting aside lingering laundry and long grass, they leave their home and go for a pleasant stroll through their neighborhood, basking together in the warm, welcoming weather.

Though Maggie is a fictional character, her circumstances resemble those of many individuals in their sixties that are preparing to make some key choices. The benefits of having a Medicare Supplement policy are significant as it can provide additional support in the years when it is extremely essential. When seeking a Medicare Supplement plan for yourself or for a loved one, we hope you acquire coverage that strongly aligns with your health needs.

 

Disclaimer: The content throughout the Unpacking Medicare Supplement blog series is for informational purposes only. It is not intended to be the basis for any decisions, be it medical, legal, or otherwise.

 

For more info, please visit ManhattanLife Medicare Supplements

Centers for Medicare & Medicaid Services. 2022. 2022 Choosing a Medigap Policy

Medicare and You 2023. Medicare & You 2023.

Guaranteed issue rights. Medicare.gov

 

 



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