Medicare Supplement

Switching Medigap in Malden: when insurers can ask health questions

MALDEN, Mass. — If you have a Medigap policy and you're thinking about moving to a different one, the first question isn't which letter plan to pick. It's whether the insurer is allowed to look at your health history before saying yes. In most of the country, that answer depends on federal law, your timing, and a handful of state rules that can quietly change the math. Here's how it works for people on Medicare in Malden.

The one window when insurers can't ask health questions

Your strongest protection is your Medigap Open Enrollment Period. It starts the month you're 65 or older AND enrolled in Part B, and it lasts six months. During that window, any Medigap insurer selling policies in your state must sell you one at the same price a healthy person pays, regardless of your medical history.

Miss that window, and the rules change. In most states, an insurer reviewing your application can look at your health, ask questions, and either charge more or turn you down. That's what "medical underwriting" means, and it's the single biggest reason people hesitate to switch plans later on.

Federal guaranteed-issue rights: the built-in safety net

Federal law carves out situations where you can buy certain Medigap plans without underwriting, even years after your original enrollment window closed. These are called guaranteed-issue rights, and they usually apply for 63 days after a qualifying event. Common examples include:

• Your Medicare Advantage plan leaves your area or stops covering you.
• You move out of your plan's service area.
• Your employer or union coverage that worked with Medicare ends.
• You joined Medicare Advantage at 65 for the first time and want to switch back within 12 months (the "trial right").
• Your Medigap insurance company goes bankrupt or you lose coverage through no fault of your own.

The specific Medigap plans you can buy under guaranteed issue depend on which situation applies. Medicare.gov keeps a plain-English chart of these scenarios, and it's worth reading before you make any changes.

State rules that go beyond the federal floor

States are allowed to give residents more protections than federal law requires, and several do. Three patterns show up most often:

• Birthday rules let you switch to an equal or lesser Medigap plan around your birthday each year without underwriting.
• Anniversary rules work similarly, tied to the date you bought your current policy.
• Continuous or year-round open enrollment lets residents change Medigap plans at any time without health questions.

These rules vary a lot from state to state, and they change. If you live in Malden, don't rely on what a friend in another state tells you. Massachusetts regulates Medigap differently than most states — the policies themselves are structured differently — so confirm what applies to you today by calling SHINE, the state's free Medicare counseling program, or the Massachusetts Division of Insurance.

What this means if you live in Malden

Malden is in Middlesex County, and Medicare Advantage and Part D plan availability is set at the county level. Medigap, though, is regulated by the state, so your switching rights depend on Massachusetts rules, not county lines.

Before you apply to switch, it helps to:

1. Write down why you want to change — cost, network, travel, or a benefit you don't use. 2. Check whether a guaranteed-issue right currently applies to you. 3. Ask SHINE whether any state rule opens a window for you right now. 4. Only then compare specific policies, and don't cancel your current one until the new coverage is confirmed.

A quick note on 2026 program figures

While you're reviewing coverage, a few 2026 Medicare numbers are worth knowing. The Part D out-of-pocket cap is $2,100, the maximum Part D deductible is $615, and the coverage gap ("donut hole") is gone as of 2025. The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments. Income-related surcharges (IRMAA) begin above $109,000 for a single filer in 2026. None of these affect Medigap directly, but they shape the full picture of what your coverage costs.