Medicare Supplement

Racine at 65: the Medigap rule that protects you now but not later

Racine, Wisconsin — If you are approaching 65 in Racine, there is one stretch of time on the Medicare calendar that quietly carries more weight than most people realize. It is called the Medigap Open Enrollment Period, and it lasts six months. Miss it, and the rules for buying a Medicare Supplement policy change in ways that can follow you for years.

Here is what that window is, why it matters, and what shifts after it closes.

What the Medigap Open Enrollment Period 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.

The Medigap Open Enrollment Period is a federal protection. It begins the first month you are both 65 or older and enrolled in Medicare Part B, and it runs for six months. During that window, you have what Medicare calls a "guaranteed issue right." That means:

• You can buy any Medigap policy sold in your state.
• The insurer cannot turn you down because of your health.
• The insurer cannot charge you more because of past or current medical conditions.

This window opens once. For most people, it does not come back.

Why Racine residents should mark it on the calendar

Racine is in Racine County, and while Medicare Advantage plan availability is set at the county level, Medigap rules are set at the state and federal level. Wisconsin is actually one of three states (along with Massachusetts and Minnesota) that standardizes Medigap policies differently than the rest of the country. The plans look a little different here, but the six-month open enrollment protection still applies.

The timing matters because your window is tied to your Part B start date, not to the fall Annual Enrollment Period most people hear about. If you turn 65 in April and your Part B begins April 1, your Medigap window runs April through September. That is your one shot at guaranteed acceptance.

What changes after the six months close

Once the window ends, insurers in Wisconsin can generally use medical underwriting when you apply for a Medigap policy. Underwriting means the insurer looks at your health history and decides whether to offer you a policy, and at what price.

After your open enrollment period, an insurer may:

• Ask detailed health questions.
• Charge you a higher premium based on your health.
• Delay coverage for a pre-existing condition.
• Decline your application altogether.

There are a few limited situations later in life — called guaranteed issue rights — where you get another protected chance to buy a Medigap policy, such as losing certain other coverage. But those are narrow, and none of them are as broad as your initial six-month window.

How Medigap fits with the rest of Medicare

Medigap works alongside Original Medicare (Part A and Part B). It does not include prescription drug coverage, so most people who choose Medigap also enroll in a stand-alone Part D drug plan. For 2026, Part D has a maximum deductible of $615 and a new $2,100 annual out-of-pocket cap on covered drugs. The old coverage gap, or "donut hole," was eliminated in 2025, so Part D now has three phases instead of four. There is also an optional Medicare Prescription Payment Plan that lets you spread drug costs across the year in monthly amounts.

Medigap is different from Medicare Advantage (Part C). You generally cannot have both at the same time. That is a decision worth thinking through before your six-month window closes, because switching from Advantage back to Original Medicare with a Medigap policy later can trigger underwriting.

How to decide during your window

A few practical steps for Racine readers approaching 65:

1. Confirm your Part B start date. That anchors your Medigap window. 2. Decide whether you want Original Medicare with a Medigap and Part D plan, or a Medicare Advantage plan. This choice shapes everything else. 3. If you lean toward Medigap, compare the standardized Wisconsin plan designs and shop among licensed insurers before your six months end. 4. Get free, unbiased help. Wisconsin's SHIP program — known here as the Medigap Helpline — offers no-cost counseling to Medicare beneficiaries.

Higher-income retirees should also know that IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.