For those who are just starting to enter the world of Medicare, understanding the Medigap Enrollment Period is essential. It’s the key to finding the right supplemental health coverage, without overpaying or under-insuring.
Medigap policies, also known as Medicare Supplement Insurance, help pay for healthcare costs not covered by Original Medicare; like copays or deductibles. However, knowing the right time to enroll in a Medigap plan can mean a difference in your coverage, what you’ll pay, and what benefits you’re entitled to.
Below, we break down everything you need to know about the Medigap Open Enrollment Period, including eligibility rules, state laws, guaranteed issue rights, and how Medigap interacts with Medicare Advantage or other types of health insurance.
What Is the Medigap Open Enrollment Period?
The Medigap Open Enrollment Period is a one-time, six-month window that begins in the first month that you’re both 65 or older and enrolled in Medicare Part B.
During this time frame, insurance companies must offer you coverage at the best available rate, regardless of your health status or any preexisting conditions you may have. You can choose from any policy offered in your state, and your application must be accepted. That means that during this period, you can get the best possible coverage for the lowest possible price.
With prices at their lowest and acceptance at its highest, this is the best time to buy a Medicare Supplement Insurance policy. You can still apply for Medigap after this window, but you may end up facing medical underwriting, which means you could be denied coverage or pay higher insurance premiums based on your health history.
Eligibility for Medigap Enrollment
To be eligible for a Medigap (Medicare Supplement Insurance) policy, you must be enrolled in both Medicare Part A and Part B. It’s important to note that while some states allow people under 65 with disabilities or certain medical conditions to buy Medigap policies, insurers in those cases may not be required to sell them or may charge higher premiums, regardless of the Open Enrollment period.
Medigap Enrollment for Those Under 65
If you’re under 65 and qualify for Medicare due to a disability, you can apply for a Medigap policy once you receive your Medicare card and Part B coverage.
There is no federally mandated Medigap Open Enrollment Period for those under 65, but some states do have laws that require Medigap insurers to offer at least one plan for people under 65. Coverage options and pricing vary widely depending on the state, so check with your State Insurance Department to review your rights and plan availability.
If you qualify for Medicare before 65 and enroll in Medigap, you may also get a second Medigap Open Enrollment Period when you turn 65. Enjoy the extra savings!
Pre-existing Condition Waiting Period
Even though you can’t be charged more for a pre-existing condition during your Medigap Open Enrollment Period, insurance companies may still have a waiting period. Don’t panic; it’s only if you don’t have creditable coverage in the six months before your application.
Creditable coverage refers to previous health insurance that provided similar benefits to Medigap. So if you have at least six months of continuous creditable coverage before you purchase a Medigap plan, the waiting period is waived.
If you weren’t covered beforehand, insurers may delay your new coverage for up to six months for pre-existing conditions.
Guaranteed Issue Rights
Outside the Medigap Open Enrollment Period, you can still buy a Medigap plan if you qualify for guaranteed issue rights.
These are special protections under federal law that require insurance companies to sell you a policy at the standard rate. They also block medical underwriting and can waive any waiting period for pre-existing conditions.
Situations that trigger guaranteed issue rights may include:
- You lost employer-based health coverage
- Your Medicare Advantage Plan leaves your area or stops offering coverage
- You go back to Original Medicare within 12 months of trying a Medicare Advantage Plan for the first time
- You move out of your Medicare Advantage Plan’s service area
You typically have 63 days from the end of your previous coverage to take advantage of these rights.
Switching from Medicare Advantage Plan to Medigap
If you’re enrolled in a Medicare Advantage Plan and want to switch to Original Medicare plus a Medigap plan, the timing matters.
You can switch during the Medicare Open Enrollment Period (October 15th to December 7th), or during the Medicare Advantage Open Enrollment Period (January 1st March 31st).
However, you must first drop your Medicare Advantage Plan and return to Original Medicare. If you’re within 12 months of first enrolling in a Medicare Advantage Plan and decide it’s not right for you, you may be eligible for a trial right exception. This exception allows you to switch to a Medigap plan without risking any underwriting.
Outside of the Medigap Open Enrollment Period
If you’re applying for Medigap after your open enrollment or guaranteed issue window, insurance companies are allowed to:
- Deny your application based on medical history
- Charge higher premiums
- Require a six-month waiting period for pre-existing conditions
This is pretty much everything you want to avoid. That’s why it’s so important to understand and act during your protected enrollment periods. In some cases, the cost of waiting can be significant, both in terms of coverage and long-term affordability. Don’t pay more for less.
State Laws and Trial Rights
Some states go above and beyond federal Medigap protections, offering additional enrollment rights or requiring insurers to sell Medigap plans to people under 65.
Examples of State Variations:
- California and Oregon offer a 30-day birthday rule, letting you switch Medigap plans with equal or lesser benefits each year around your birthday.
- Missouri allows annual Medigap plan switching during the anniversary month, with guaranteed issue rights.
- New York and Connecticut offer continuous guaranteed issue rights, allowing residents to switch Medigap plans any time.
It’s important to understand your state-specific laws and how they can impact your coverage, premiums, and ability to switch plans without penalties.
Annual Medicare Open Enrollment Period
From October 15th to December 7th, Medicare beneficiaries can make changes to their Medicare coverage during the Annual Medicare Open Enrollment Period. This includes:
- Switching from Original Medicare to a Medicare Advantage Plan
- Switching from a Medicare Advantage Plan back to Original Medicare
- Enrolling in, dropping, or switching a Medicare Part D prescription drug plan
However, this is not the same as the Medigap Open Enrollment Period. You cannot enroll in a Medigap plan during this time without being subject to underwriting, unless you qualify for guaranteed issue rights.
Resources for Medicare Beneficiaries
Making decisions about Medigap policies can be overwhelming. Fortunately, there are resources to help you make informed choices:
- Medicare.gov: Offers tools to compare Medigap plans and Part D coverage
- Medigap Plan Finder: Helps you see what’s available in your state
- Medicare & You Handbook: Outlines the Medicare basics and updates
- State Health Insurance Assistance Program (SHIP): Offers free counseling to help you choose a plan
- Insurance Agents/Brokers: Experts (like the ones at Medicare School) can explain your health insurance options and help you enroll in a plan that meets your needs
- Medicare Cost Estimation Guide: This guide will show you how to closely estimate your anticipated Medicare costs so there’s no surprises down the road.
As always, be careful when using private brokers. Make sure they’re licensed and independent, so they can offer a wide range of insurance company options rather than steering you toward specific plans.
Understanding your Medigap enrollment period, the rights you have in the process, and how to avoid Medicare mistakes is essential for securing quality health coverage at the best possible rate. While the Medigap Open Enrollment Period offers the broadest protections, other avenues such as guaranteed issue rights, state laws, and trial rights can also help you get covered—even if you missed your first window.
Don’t wait to apply. It could mean higher out-of-pocket costs, limited choices, or even a complete denial of coverage. Educate yourself, explore your state’s laws, and get assistance from licensed professionals to make sure you’re taking advantage of this incredible opportunity.
With the right timing and information, you can make confident decisions about your Medicare Supplement Insurance, protecting your finances and peace of mind throughout retirement.
Need help navigating your Medigap options? Visit MedicareSchool.com to watch America’s #1 Medicare Education Workshop or schedule a call with a licensed Medicare advisor for personalized support.
Frequently Asked Questions (FAQ) About Medigap Enrollment
Can I enroll in a Medigap plan at any time?
Technically, yes—but outside your Medigap Open Enrollment Period or a guaranteed issue window, insurance companies can deny your application, charge higher premiums, or impose waiting periods based on your health history.
What is the best time to enroll in a Medigap plan?
The best time is during your Medigap Open Enrollment Period—a six-month window that begins when you are 65 or older and enrolled in Medicare Part B. During this time, you have guaranteed issue rights and can’t be charged more due to pre-existing conditions.
What if I’m under 65 and on Medicare due to disability?
Federal law doesn’t guarantee Medigap rights for people under 65, but some states require insurers to offer at least one plan.
Can I switch Medigap plans later if I’m unhappy with my coverage?
In most states, you can apply to switch plans at any time, but unless you have guaranteed issue rights or live in a state with flexible switching laws (like NY, CT, CA, MO), you could face extra costs or have your application denied.
Is Medigap the same as Medicare Advantage?
No. Medigap works with Original Medicare to cover out-of-pocket costs, while Medicare Advantage replaces Original Medicare with an all-in-one private plan. You cannot be enrolled in both Medigap and a Medicare Advantage plan at the same time.
What is a guaranteed issue right?
A guaranteed issue right is a special protection that requires Medigap insurers to sell you a policy without considering your health history. These rights apply in certain situations—such as losing other coverage or leaving a Medicare Advantage plan within the first year.
Will Medigap cover my prescription drugs?
No. Medigap policies sold after 2006 do not include drug coverage. To get prescription drug coverage, you’ll need to enroll in a separate Medicare Part D plan.
What happens if I miss my Medigap Open Enrollment Period?
You can still apply for a plan, but the insurer might deny you or charge higher premiums. Some people also face a six-month waiting period for pre-existing conditions unless they had continuous creditable coverage before applying.