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The best time to purchase a Medigap policy is during your Medigap open enrollment period. This period lasts six months and begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B. So if you turn 65 on April 3 but don't join Medicare B until May 25, your Medigap open enrollment period will start on June 1, which is the first day of the month in which you are both 65 and enrolled in Part B.
Important: Once your open enrollment period starts, it cannot be delayed or replaced.
Some states have an open enrollment period for eligible individuals under the age of 65, and a second enrollment period when they turn 65. If you are under 65, check with your State Insurance Department for guidelines.
Why is it important to buy a policy during the open enrollment period?
Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge for the policy. But during your open enrollment period, an insurance company cannot do any of the following, even if you have a disability or health problem:
- Refuse to sell you any Medigap policy it offers
- Charge you a higher premium than they charge others who are 65 and older
- Delay the start of your coverage
What is a pre-existing condition waiting period?
Although an insurance company can't delay the start of your overall coverage during open enrollment, in some cases it may be able to make you wait for coverage related to a pre-existing condition. If the Medigap insurance company has a pre-existing condition waiting period, it can refuse to cover your out-of-pocket costs for any services related to this condition for up to six months. (Original Medicare will continue to cover the condition during this time, but you will have to pay the coinsurance or copayment.) After six months, the Medigap policy will cover the pre-existing condition.
A Medigap insurance company can delay coverage only if the condition was treated or diagnosed within the six-month period before your policy starts. Here are some examples to show you what could be considered a pre-existing condition:
|Your health situation||Is this considered a pre-existing condition?|
|You have a long-term condition, such as diabetes, that you take medication for on a daily basis.||Yes|
|Five months ago, your doctor diagnosed you with hypertension.||Yes|
|Last year you were treated for back pain, but you have not been treated for this condition in the past 10 months.||No|
Is it possible to avoid or shorten the waiting period?
You can avoid or shorten waiting periods for pre-existing conditions if you meet the following criteria:
- You buy a Medigap policy during your open enrollment period, and
- You are replacing creditable health coverage, and
- You've had at least 6 months of continuous prior coverage, and
- You did not have a break in coverage for more than 63 days
In addition, if you buy a policy when you have a guaranteed issue right, the insurance company can't use a pre existing condition waiting period.
What if I wait to enroll in Medicare Part B?
In most cases, it's best to enroll in Medicare Part B when you're first eligible in order to avoid paying the Part B late enrollment penalty. However, if you or your spouse are working and have good group health insurance through an employer or union, you may want to delay Part B, even after you turn 65. If and when your employer coverage ends, you can enroll in Part B without a penalty. Your Medigap six-month open enrollment period will begin at this time.
However, if you enroll in Part B while you still have employer-sponsored coverage, the Medigap open enrollment clock will start ticking. Unless you buy a Medigap policy before you need it—in other words, while you still have coverage through your employer—you will lose your open enrollment period.
Every company and union has different rules, so for more information on how your insurance works with Medicare, it's best to contact your employer or union benefits administrator.
What if my Medigap open enrollment period has passed?
If you apply for a Medigap policy after your open enrollment period ends, there's no guarantee your application will be accepted if you don't meet medical underwriting requirements, except under certain limited situations. Click here for more information on situations in which you may still have a guaranteed right to buy a Medigap policy after your open enrollment ends.