Medicare Supplement

Switching Medigap in Costa Mesa: when underwriting applies and when it can't

In Costa Mesa, plenty of people on Original Medicare carry a Medigap policy to help with the out-of-pocket costs Part A and Part B leave behind. But what happens when you want to switch to a different Medigap plan — maybe for a lower premium, a different letter plan, or a new insurer? The answer depends on timing. Sometimes you can switch with no health questions asked. Other times, the insurer can look at your medical history and decide whether to accept you, charge you more, or turn you down.

Here's what to know before you make a move.

The one window where no one can turn you down

Your Medigap Open Enrollment Period is a six-month window that starts the first month you're 65 or older AND enrolled in Part B. During that time, any insurer selling Medigap in your state must sell you any plan they offer at their best available rate, regardless of your health history.

This window happens once. After it closes, the rules change — and that's where most of the confusion about "switching" starts.

After that: medical underwriting is the default

Once your Medigap Open Enrollment Period ends, insurers in most states can use medical underwriting if you apply for a new policy or switch plans. That means they can ask about your health, look at prescriptions and conditions, and decide whether to:

• accept your application at standard rates,
• accept it at a higher rate, or
• deny it altogether.

This is why many Medicare counselors tell people: don't cancel your current Medigap policy until the new one is approved and in force. Costa Mesa residents are in Orange County, where several insurers sell Medigap, but availability doesn't mean automatic acceptance after your first open window.

Federal guaranteed-issue rights: the exceptions

Federal law carves out specific situations where insurers must sell you certain Medigap plans without underwriting. These are called guaranteed-issue rights, and they usually apply for a limited time (often 63 days). A few common examples:

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

The plans you're guaranteed to be sold, and the deadlines, depend on the situation. The full rules are at medicare.gov under "Medigap."

State rules that can give you more room

Beyond the federal protections, some states have added their own. These rules go by different names:

• Birthday rule — a window around your birthday each year to switch to an equal or lesser Medigap plan without underwriting.
• Anniversary rule — a window tied to your policy's anniversary.
• Continuous or year-round open enrollment — some states let you change Medigap plans at any time without health questions.

California is one of the states that has historically offered a birthday-rule-style protection, but the specifics — the length of the window, which plans you can switch to, and whether you must stay with the same insurer or can change carriers — can change. Before you rely on it, confirm the current rule with California's SHIP, called HICAP (Health Insurance Counseling & Advocacy Program), or the California Department of Insurance. A quick call can save you a costly mistake.

Common mistakes to avoid

• Canceling first, applying second. Always wait until the new policy is approved.
• Assuming all states work the same way. Medigap rules are federal at the floor, but states can add protections. If you move, the rules can change.
• Missing a 63-day window. Most guaranteed-issue rights are short. Mark the calendar.
• Confusing Medicare Advantage enrollment periods with Medigap rules. The Annual Enrollment Period (Oct. 15 – Dec. 7) and the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) are for Advantage and Part D — not Medigap.
• Not comparing the same letter plan. A Plan G is a Plan G in terms of benefits — the differences across insurers are mostly price, service, and rate history.