Switching Medigap plans

The one window nobody gets back

Your Medigap Open Enrollment Period runs six months. It starts the first month you are both 65 or older and enrolled in Part B, and it does not repeat — it is a one-time enrollment, unlike the annual Medicare Open Enrollment you hear advertised each autumn.^{[Medicare.gov]}

Inside it, an insurer cannot refuse you or charge you more because of your health. Outside it, unless you hold a guaranteed issue right, an insurer may use medical underwriting and may decline your application outright.^{[Medicare.gov]}

That asymmetry is the single most important fact on this page. It is also why a plan that looks cheap at 65 deserves scrutiny about what it will cost at 80 — because by 80, leaving it may not be your decision to make. How the pricing methods differ.

Guaranteed issue rights: when the door reopens

Federal law reopens the door in specific circumstances. When you have a guaranteed issue right, an insurer must sell you a policy, must cover your pre-existing conditions, and cannot charge you more because of your health.^{[Medicare.gov]}

Most of these arise when other coverage you hold changes or ends. One is worth knowing by name because people stumble into it without realising:

The Medicare Advantage trial right. If you dropped a Medigap policy to try a Medicare Advantage plan for the first time, have been in it less than a year, and want to come back, you have a guaranteed issue right to buy your former policy back if the company still sells it — and if not, to buy Plan A, B, D, G, K or L in your state.^{[Medicare.gov]}

The full list of qualifying situations, with the paperwork each requires, is in Medicare’s official guide.^{[Centers for Medicare & Medicaid Services]} If you think one applies to you, get the letter proving your other coverage ended — insurers will ask for it, and the clock on these rights is short.

What your state may add on top

The federal rules are a floor, not a ceiling. 16 states go beyond it, and we have read 16 of those 16 in the state’s own material and cited it below. A one-word label like “birthday rule” hides the parts that decide whether you can actually move, so the summaries here carry the limits.

Every state above links to the material we read it in. The remaining 35 states are, as far as we have found, on the federal floor — which is not the same as having proved it. State rules change by legislation; confirm the current wording with your insurance department or your free counselling programme before acting.

Three examples of why the label is not enough, all from the table above. Illinois caps its birthday rule at ages 65 to 75 and confines it to your existing insurer, so it will not move you to a different company. Nevada’s reaches carriers with open blocks of business, which may exclude the closed block you are trying to leave. Maine is widely described as year-round guaranteed issue and is not: each insurer picks one month a year, and only Plan A has to be offered in it.

The two traps in the mechanics

Suppose you can switch and you have decided to. Two procedural details cost people real money every year.

Do not cancel the old policy first. Get the new policy in force before you cancel the old one. You will pay both premiums for the overlapping month, and that is the correct outcome — it is the price of not ending up uninsured if the new application fails.^{[Medicare.gov]} A new policy also carries a 30-day free look, so you have a window to change your mind.^{[Medicare.gov]}

The pre-existing condition waiting period. If you have held your current Medigap policy less than six months and switch, the new insurer may make you wait up to six months before it covers a pre-existing condition.^{[Medicare.gov]} After six months it must cover it. Worth planning around if you are treating something now.

Before you move, compare the right thing

The mistake we see most often: comparing this month’s premium and nothing else.

Benefits by plan letter are standardised, so a Plan G is a Plan G whoever sells it. What is not standardised is what the block you are joining has done with its rates, and what it is likely to keep doing. A policy $15 cheaper today, sitting in a block that has filed double-digit increases three years running, is more expensive within two years and worse every year after that.

Four questions to ask about any policy you are considering:

1. Which legal entity issues it, and what is its NAIC number?
2. Attained-age, issue-age or community-rated?
3. What has that entity filed for, in this state, over the last five years?
4. Is the policy form still open to new applicants?

Rate history by state and plan is where we answer the third and fourth.

If you cannot switch

It is worth saying plainly, because most sites in this business will not: sometimes the answer is that you should stay where you are.

If you are outside your open enrollment window, hold no guaranteed issue right, live in a state with no standing switching rule, and would not pass underwriting, then your Medigap policy is the coverage you have. It is guaranteed renewable — the insurer cannot cancel it while you pay.^{[Medicare.gov]} The useful work then is budgeting for the trend and re-checking each year, not chasing a move that will end in a declination.

Anyone who tells you otherwise without asking a single question about your health or your state is not giving you advice.

Free help, and what our help costs you

Every state has a State Health Insurance Assistance Program (SHIP) giving free, unbiased, one-to-one Medicare counselling, federally funded through the Administration for Community Living.^{[SHIP National Technical Assistance Center][Administration for Community Living, U.S. Department of Health and Human Services]} They sell nothing and are funded federally rather than by carriers.

We are a licensed agency, and carriers pay us when someone buys through us. Worth being precise about what that means for you: you pay the same premium whichever way you buy: the commission comes out of the carrier's filed rate, it is never added to yours. Going direct to the insurer does not make the policy cheaper, and using us does not make it dearer. The difference between us and the counselling service is that they cannot sell you a policy and we can — not that one of us is cheaper.

Find yours through the SHIP locator or by calling 1-877-839-2675. If you want a second opinion on anything we tell you, that is where we would send you too.