Medicare Supplement

Can a Medigap insurer say no when you switch?

SANFORD, Fla. — If you have a Medicare Supplement (Medigap) policy and you've been thinking about moving to a different plan letter or a different insurer, the first question isn't which policy looks appealing. It's whether the insurer can ask about your health before saying yes. That single detail — called medical underwriting — decides whether switching is straightforward or complicated, and the rules are a mix of federal protections and state-level add-ons that vary widely.

Here's what Sanford residents should understand before making a move.

Why timing matters more than the plan letter

Medigap plans are standardized by letter (Plan G, Plan N, and so on), so the benefits inside a given letter are the same from company to company. What changes between insurers is the premium — and, when you switch, whether they'll take you at all.

When you first enrolled in Medicare Part B at 65, you had a six-month Medigap Open Enrollment Period. During that window, insurers had to sell you any Medigap policy they offered at their best available rate, regardless of your health. That one-time window is the easiest time to buy Medigap. According to Medicare.gov, once it closes, federal law no longer requires insurers to sell you a policy — unless you fall into a guaranteed-issue situation.

When federal guaranteed-issue rights kick in

Federal law protects your right to buy certain Medigap policies without medical underwriting in specific circumstances. Common examples listed by Medicare include:

• Your Medicare Advantage plan is leaving Medicare, stops serving your area, or you move out of its service area.
• You're in a Medicare SELECT policy and you move out of its service area.
• Your Medigap insurer goes bankrupt or ends your coverage through no fault of your own.
• You dropped a Medigap policy to try Medicare Advantage for the first time and want to switch back within 12 months (often called the "trial right").

In these situations, you typically have a 63-day window to apply, and the insurer can't turn you down or charge you more because of your health. The specific Medigap plans you're eligible for depend on which protection applies to you.

When underwriting usually applies

If you're simply unhappy with your current Medigap premium, want to try a different plan letter, or want to switch carriers to shop pricing, federal law does not require any insurer to accept you. In that case, insurers in most states can:

• Ask detailed health questions on the application.
• Look at prescription and medical history.
• Charge a higher rate, add a waiting period for pre-existing conditions, or decline the application.

That doesn't mean you shouldn't try — many people in good health switch successfully. It just means the outcome isn't guaranteed, and you shouldn't cancel your existing policy until the new one is officially in force.

The state layer: birthday, anniversary, and continuous open enrollment rules

A growing number of states have added their own switching rights on top of the federal ones. Depending on the state, these can include:

• Birthday rules — a window around your birthday each year to switch to a Medigap plan with equal or lesser benefits without underwriting.
• Anniversary rules — a window tied to the anniversary of your policy start date.
• Continuous or year-round open enrollment — the ability to change Medigap plans at any time without health questions.

These state rules change, and they don't apply everywhere. If you live in Sanford, the safest step is to confirm what currently applies in Florida directly with SHINE (Serving Health Insurance Needs of Elders), Florida's State Health Insurance Assistance Program, or the Florida Office of Insurance Regulation. Don't rely on marketing calls or mailers to describe your state's rules accurately.

A practical checklist before you switch

• Write down your current plan letter, insurer, premium, and start date.
• Decide what you want to change — the letter, the insurer, or both.
• Call SHINE or 1-800-MEDICARE to ask whether any guaranteed-issue right or Florida-specific rule applies to your situation.
• Apply for the new policy and get a written approval before canceling the old one.
• Confirm the effective date of the new coverage in writing.

Seminole County residents can reach SHINE counselors for free, unbiased help — they don't sell insurance and aren't tied to any carrier.