Medicare Supplement

Thinking of Switching Medigap? Read This First

Oklahoma City — If you have a Medicare Supplement (Medigap) policy and you've been thinking about switching to a different one, the rules about when you can switch — and whether an insurer can charge you more or turn you down — can be confusing. The short version: you have a strong federal right to buy Medigap when you first sign up, but after that, your ability to change plans depends on a mix of federal protections, state laws and, in many cases, the insurance company's willingness to accept you.

Here's what Oklahoma City readers should know before making a move.

Your one-time Medigap Open Enrollment Period is the strongest window

Under federal rules, your Medigap Open Enrollment Period is a six-month window that starts the month you're 65 or older and enrolled in Part B. During this window, any Medigap insurer that sells policies in your area must sell you one at the best available rate, no matter your health history.

That is the only time federal law gives you an unconditional right to buy any Medigap policy sold in your state. Once it closes, the rules change.

After that window, medical underwriting is usually on the table

Once your Medigap Open Enrollment Period ends, insurers in most states — including Oklahoma — can generally ask health questions when you apply to switch to a new Medigap policy. Based on your answers, they may:

• Approve you at standard rates,
• Charge you a higher premium, or
• Turn down your application altogether.

This is called medical underwriting. It's the main reason a lot of people stay in a Medigap policy they've outgrown: they're afraid they won't qualify for a new one. The healthier you are when you apply, the better your chances — but there are no guarantees outside of the special situations below.

Federal guaranteed-issue rights: your safety net in certain situations

Federal law spells out several "guaranteed-issue" situations where insurers must sell you certain Medigap policies without underwriting, usually within 63 days of a qualifying event. Common examples include:

• Your Medicare Advantage plan leaves Medicare or stops serving your area.
• You move out of your plan's service area.
• Your employer or union coverage that paid after Medicare is ending.
• Your Medigap insurance company goes bankrupt or you lose the coverage through no fault of your own.
• You joined a Medicare Advantage plan when you first became eligible for Medicare and want to switch back to Original Medicare within your first year (the "trial right").

The specific Medigap plans available under a guaranteed-issue right can be limited, so it's worth reading medicare.gov's Medigap guide carefully, or calling 1-800-MEDICARE, before you make a change.

State add-ons: birthday rules, anniversary rules and continuous open enrollment

On top of federal law, some states have added their own protections. Depending on the state, these can include:

• A birthday rule, letting you switch to an equal or lesser Medigap plan around your birthday each year without underwriting.
• An anniversary rule, tied to the date you first bought your current policy.
• Continuous or year-round open enrollment, where insurers can't use health underwriting at all.

These rules vary widely and change over time. Oklahoma isn't among the states most commonly cited for a birthday or anniversary rule, but state rules do get updated, so don't rely on what a neighbor in another state tells you. Confirm what applies in Oklahoma today by calling the free Senior Health Insurance Counseling Program (SHIP) run through the Oklahoma Insurance Department, or by checking with the department directly.

A word about Oklahoma City and county-level coverage

Oklahoma City sits mostly in Oklahoma County, with parts extending into Cleveland, Canadian and Pottawatomie counties. Unlike Medicare Advantage and Part D plans, which are sold based on the county you live in, Medigap policies are regulated at the state level. That means the same Medigap rules generally apply across Oklahoma, no matter which of those counties you call home — but which specific policies are offered, and at what price, depends on the insurance companies licensed in Oklahoma.

Before you switch, do these four things

1. Don't cancel your current policy first. You typically have a 30-day "free look" period after buying a new Medigap policy to decide whether to keep it. Keep paying premiums on the old one until you're sure. 2. Ask if you'll be underwritten. Call the new insurer and ask directly whether health questions apply and whether you qualify for a guaranteed-issue right. 3. Compare apples to apples. Medigap plans are standardized by letter (Plan G, Plan N, etc.), so the benefits within a lettered plan are the same across companies — but premiums and customer service can differ. 4. Get free, unbiased help. Oklahoma's SHIP counselors don't sell insurance and don't earn commissions.