Why a plan ending can open the door to Medigap
Medigap companies can normally ask health questions and turn you down if you apply outside your first six months with Part B. A guaranteed issue right is a protection for certain situations where that is not allowed.
- Your plan is leaving Medicare.
- Your plan stops giving care in your area.
- You move out of the plan's service area.
- Your plan's network has a significant change.
What the company must do
In a guaranteed issue situation the insurance company must sell you a Medigap policy, must cover all of your pre-existing health conditions, and cannot charge you more because of past or present health problems.
- You only have this right if you switch to Original Medicare. If you join another Medicare Advantage plan instead, you do not get a guaranteed right to buy Medigap.
- Medigap coverage cannot start until your Medicare Advantage coverage ends.
What Medigap does and does not do
Medigap helps pay costs that Original Medicare leaves, such as deductibles, coinsurance and copayments, depending on the plan letter you pick. It does not include prescription drug coverage, and most Medigap policies do not include routine dental, vision or hearing.
- You can usually see any doctor or hospital that accepts Medicare, without a network.
- You keep paying your Part B premium and the Medigap company's premium.
- You will need a separate Medicare drug plan.
What to do first
The date on your letter drives everything. Write it down today, then call. The right to buy Medigap without health questions does not last, and waiting past the window can mean being turned down or paying more.