When Can You Buy a Medigap Policy?

Calendar Icon Updated January 15, 2019
Medicare

A Medigap policy is a private insurance policy that you can buy to cover some or most of the out-of-pocket expenses associated with Original Medicare. (Those who have a Medicare Part C Advantage Plan cannot purchase a Medigap policy.)

The optimal time to purchase a Medigap policy is during the six-month Medigap open enrollment period. The six-month period begins the month that you are both:

  • 65 years old and
  • enrolled in Medicare Part B (medical insurance).

There is a very good reason why this is the best time to buy a Medigap policy. Insurance companies are usually allowed to use medical underwriting when deciding whether to sell you a policy and can charge you more based on your health status. However, during the open enrollment period, you can purchase any Medigap policy sold in your state, for the same price as those in good health—even if you have health problems.

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Purchasing a Medigap Policy Outside of the Open Enrollment Period

If you apply for Medigap coverage outside of the open enrollment period, you may not be able to get a policy from an insurance company unless you meet the medical underwriting requirements. In cases where you are able to buy one, it may cost more.

However, if you have a guaranteed issue right, you are entitled to buy a policy outside of the open enrollment period without medical underwriting.

What Are Guaranteed Issue Rights?

Guaranteed issue rights (which are often called “Medigap protections”) refers to certain situations when insurance companies, by law, cannot refuse to sell you a Medigap policy even if you have health problems, which are called “pre-existing conditions.”

If you have a guaranteed issue right, an insurance company is required to sell you a Medigap policy that covers your pre-existing conditions. The company also can’t charge you more for the Medigap policy because of your past or present health problems.

Who Has a Guaranteed Issue Right

Generally, you have a guaranteed issue right if your other health coverage somehow changes. For instance, you have a guaranteed issue right (and an insurance company must sell you a Medigap policy if you want one) in the following situations (among others):

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  • You’re enrolled in a Medicare Advantage Plan (Medicare Part C) and your plan is leaving the Medicare program. (This right only kicks in if you switch to Original Medicare rather than choosing to join another Medicare Advantage Plan.)
  • You’re enrolled in a Medicare Advantage Plan (Medicare Part C) and your plan stops offering care in your area. (This only applies if you change to Original Medicare.)
  • You’re enrolled in a Medicare Advantage Plan (Medicare Part C) and you move out of the plan’s service area. (Again, this is only applicable if you switch to Original Medicare.)
  • Your Medigap insurance company goes bankrupt and, as a result, you lose your coverage.

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