Medicare Supplement

Can insurers ask about your health when you switch?

ALAMEDA, Calif. — If you have a Medigap policy and you're thinking about moving to a different one, the single biggest question is not which plan letter to pick. It's whether the new insurer is allowed to ask about your health.

Medicare SupplementAlameda, CA

That one detail decides whether you can switch easily, whether you might pay more, or whether you could be turned down. The rules come from three places: federal Medigap protections, your state, and the insurer's own underwriting. Here's how they fit together for readers in Alameda, which is in Alameda County, California.

The default rule: underwriting applies

Medigap policies are sold by private insurers, but the basic rules come from federal law. When you first sign up for Medicare Part B at age 65 or older, you get a six-month Medigap Open Enrollment Period. During that one-time window, any insurer selling Medigap in your area must sell you any policy they offer, at their best available rate for your age, without asking health questions.

Once that window closes, the default flips. If you apply to switch later, the insurer can usually ask about your health, look at your prescription history, and either charge you more, offer a different plan, or turn you down. That is called medical underwriting, and it is legal in most cases outside of a protected situation.

This is why many people who are healthy shop their Medigap coverage — and why people managing chronic conditions need to plan a switch more carefully.

Federal guaranteed-issue rights

Federal law creates a short list of situations where you can buy certain Medigap policies without underwriting, even after your first enrollment window is gone. These are called guaranteed-issue rights, and they usually last 63 days from the qualifying event.

Common examples include:

• Your Medigap insurer goes bankrupt or your policy ends through no fault of your own.
• You joined a Medicare Advantage plan when you first became eligible for Medicare, and you want to switch back to Original Medicare within your first 12 months (a "trial right").
• You dropped a Medigap policy to try Medicare Advantage for the first time, and you want to go back within 12 months.
• Your Medicare Advantage or employer/retiree coverage ends or leaves your area.

In these situations, the insurer must sell you certain Medigap plans, cannot use health status against you, and cannot impose a pre-existing condition waiting period if you had prior creditable coverage. The specific plan letters available to you depend on when you became eligible for Medicare. Medicare.gov has the current list.

What some states add on top

Federal rules are the floor, not the ceiling. Some states have added their own protections that make switching easier:

• Birthday rule — a window around your birthday each year when you can switch to an equal or lesser Medigap plan without underwriting.
• Anniversary rule — a similar window tied to the date you bought your current policy.
• Continuous or year-round open enrollment — the insurer cannot use underwriting at all, or must accept applicants during set periods each year.

California is one of the states that has added protections beyond the federal floor, but the details — including which plans qualify, how long the window lasts, and how the pricing works — change over time and depend on your situation. Before you rely on any state rule, confirm the current terms with California's State Health Insurance Assistance Program, known locally as HICAP, or with the California Department of Insurance. Do not assume a rule you read about years ago still works the same way.

Practical steps before you switch

A few habits protect you no matter which door you use to switch:

1. Apply for the new policy first. Do not cancel your current Medigap until the new insurer has approved you in writing. 2. Ask which right you're using. Underwritten application, federal guaranteed-issue, or a state rule — the paperwork and protections are different. 3. Watch the 63-day clock. Guaranteed-issue rights are time-limited from the triggering event. 4. Compare the same plan letters carefully. A Plan G is a Plan G under federal standardization — the covered benefits are the same across insurers. What differs is the premium, the company's rate history, and customer service. 5. Get help you can trust. HICAP counselors in Alameda County offer free, unbiased Medicare counseling. Medicare.gov and 1-800-MEDICARE can also walk you through your rights.