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When you apply for or already carry a Medigap policy you have certain rights. In some cases these rights are the same as with other Medicare-related insurance, in other cases they are specific to Medigap insurance plans. Medigap insurance plans are supplemental insurance that Medicare recipients can get to fill the various gaps in coverage in Original Medicare. These gaps include, but are not limited to, Original Medicare deductibles, copayments, and coinsurance.

Free-Look Period
One right you have is a 30 day free-look period. This allows you to try an insurance plan and if you are not satisfied, revert to your previous insurance plan and get a refund. You shouldn’t cancel your first insurance plan until you are sure you are going to keep the second one. The downside of this is that you may have to pay premiums for a month. But that is likely better than being stuck with a policy you do not like.

Open Enrollment Period Rights
You can buy a Medigap policy during the Medigap open enrollment period, which is the six months that follow your 65th birthday.  In some states there is an open enrollment period for eligible individuals under the age of 65, and a second one when they turn 65.  Check with your state to see if you are eligible. During this time you have specific rights. During the open enrollment period the insurance companies cannot refuse to sell you any Medigap policy they offer (they do not have to offer all of them). They also cannot charge you more for a policy because of any health problems you may have.  Insurance plans, like other products, are influenced by inflation and rising health costs.  Consequently your rate may increase over time.

Pre-existing Conditions
The specific circumstances relate to any pre-existing condition you may have. A pre-existing condition refers to a health issue you had before the start date of the policy. They cannot refuse coverage but can only delay it. This period can last up to six months. During that time, the company may not pay for any of your out-of-pocket expenses. This “pre-existing condition waiting period” applies to conditions that were diagnosed or treated within 6 months of the policies activation. They can exclude the condition for six months. After this the Medigap policy will cover the condition. During the six months your Medigap policy doesn’t cover the pre-existing condition Original Medicare will still cover their portion of the costs for that condition.

Also keep in mind that there are times when companies cannot refuse to cover a pre-existing condition. If, for instance, you had other “creditable coverage” recently for a continuous six months the Medigap company cannot make you wait for coverage of your pre-existing condition. Keep in mind this applies only when you get your policy during the Medigap open enrollment period. You will need to check with your insurer and Medicare to see if your coverage is considered “creditable.” Even if it is you cannot have had more than a 63 day break in that coverage or you may find your pre-existing condition excluded. . You can also send in your application for a Medigap insurance plan before you turn 65. This makes it easier for you to maintain continuous coverage.

Guaranteed Renewal
Every Medigap policy is “guaranteed renewable.” That means once you have the policy, and as long as you pay the premium, you cannot be dropped by your insurance company for any reason. It is important to enroll as soon as you are eligible. You become eligible for a Medigap policy once you have Medicare Part B. The open enrollment cannot be repeated or stopped once it starts.  If you are still employed at the age of 65, and are covered by your employer group insurance plan, you may want to delay enrolling in Medicare Part B.

Suspension Rights
Those under the age of 65 that have Medicare and a Medigap policy have the right to suspend that policy. The policy, along with its benefits and premiums can be suspended with no penalty, for the time you are enrolled in an employer group health insurance plan (yours or your spouse’s). If you lose that coverage, for any reason, you can get the Medigap policy back. You do have to notify your insurance company that you want the policy back within 90 days of losing the employer group insurance plan.

Under this scenario your Medigap insurance plan becomes active the same day your employer group coverage ends. The Medigap policy is required to have the same benefits it did before. It is required to be the same as if you never suspended coverage. The insurance company cannot refuse to cover pre-existing conditions. This helps people who are disabled but still working; they can have employer benefits without the anxiety of having to give up their Medigap policy permanently.

Other Rights
You also have some guaranteed rights when it comes to Medicare beyond those you enjoy in the Medigap open enrollment period. If you have coverage that changes in some way you often have a guaranteed right to a Medigap policy. You may also have a “trial right” to return to a Medigap insurance plan after you have signed up for a Medicare Advantage Plan. This is also true if your Advantage Plan stops offering your insurance plan or coverage in your area. In this case you can return to Original Medicare and buy certain Medigap insurance plans. If you have employer group coverage or COBRA and that coverage is ending. Again, you have a right to buy certain Medigap insurance plans in either case. If you have a Medicare SELECT plan, which are offered only in certain areas, and you move you have a guaranteed right to buy a Medigap policy.

If you have a Medigap policy that has been discontinued, insurance plans E, H, I or J, and that policy was issued before June 1, 2010 you have the right to keep that policy.

Remember, your state may have additional consumer protections and rights over and above Federal law. Check with them for details.