Medicare Supplement

The 6-Month Medigap Clock Sammamish Retirees Can't Reset

# The 6-Month Medigap Clock Sammamish Retirees Can't…

SAMMAMISH, Wash. — If you are turning 65 soon, there is one Medicare deadline that quietly carries more weight than almost any other: the six-month window when you can buy a Medigap policy without answering a single health question. Miss it, and the rules change for the rest of your life.

That window opens the month you are both 65 and enrolled in Medicare Part B. It closes six months later. During those six months, insurance companies in Washington must sell you any Medigap policy they offer at their best available rate, no matter your health history.

What Medigap actually is

Medigap, also called Medicare Supplement Insurance, is a private policy that helps pay some of the out-of-pocket costs Original Medicare leaves behind — things like coinsurance and hospital deductibles. It works alongside Parts A and B. It is not the same as Medicare Advantage, and you generally cannot have both at the same time.

Medigap plans are standardized and labeled by letter (Plan G, Plan N, and so on). The benefits within each letter are the same from one insurer to the next, though premiums vary.

Why this six-month window matters so much

During your Medigap Open Enrollment Period, you have what's called a guaranteed issue right. That means:

• An insurer must sell you any Medigap policy it offers.
• You cannot be turned down because of your health.
• You cannot be charged a higher premium based on past or current medical conditions.

This protection is set in federal law and administered by CMS. It is the one stretch of time when your health history simply doesn't factor into whether you can buy a supplement policy.

What changes after the window closes

Once your six months end, most insurers in Washington can require medical underwriting if you apply for a new Medigap policy or want to switch plans. That means they can:

• Ask detailed health questions.
• Delay coverage for pre-existing conditions in some cases.
• Charge a higher premium.
• Decline to sell you a policy at all.

There are a few limited situations later in life — called guaranteed issue rights — where protections return, such as when certain coverage you had ends through no fault of your own. But those are narrow exceptions, not a second open enrollment.

How this fits with your other Medicare choices

Sammamish is in King County, where Medicare beneficiaries have a broad menu of Medicare Advantage and Part D plans to consider each year. Advantage plans have their own enrollment periods — the Annual Enrollment Period runs October 15 through December 7, and the Medicare Advantage Open Enrollment Period runs January 1 through March 31.

Medigap does not follow that calendar. Its one guaranteed window is tied to your personal 65th-birthday timeline and Part B start date, not to the fall enrollment season. That is why it is easy to overlook.

A few program-level facts worth knowing as you weigh your options for 2026:

• Part D has a $2,100 out-of-pocket cap in 2026.
• The Part D deductible is capped at $615.
• The coverage gap (the old "donut hole") is gone as of 2025.
• IRMAA income surcharges start above $109,000 for a single filer in 2026.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year.

What to do before your window closes

If you are approaching 65 in Sammamish, a few practical steps can help you use your one-time window well:

1. Confirm the month your Part B coverage begins — that starts the six-month clock. 2. Decide whether Original Medicare plus Medigap, or Medicare Advantage, fits your care and budget. 3. If you are leaning Medigap, compare policies by letter (Plan G vs. Plan N, for example) and by premium. 4. Ask about how the insurer prices premiums — by age at issue, attained age, or community rating. 5. Get help. Washington's SHIBA program offers free, unbiased counseling.