Between October 15 and December 7, it’s the Medicare Annual Open Enrollment Period, during which time you have the right to enroll in traditional Medicare and disenroll from your Medicare Advantage plan. But, depending upon the circumstances surrounding your enrollment in traditional Medicare and the state you live in, you might not have the right to buy a “Medigap” policy, insurance that fills gaps in traditional Medicare. And, since traditional Medicare does not have an out-of-pocket limit, without supplemental coverage, you put yourself at grave financial risk.
To be clear, unlike Medicare Advantage, which has an annual out-of-pocket maximum, traditional Medicare has no maximum. But, unlike Medicare Advantage which requires you to pay copays that can total thousands of dollars a year in order to get care, with traditional Medicare you can protect yourself financially through supplemental insurance that fills gaps. You can get supplemental insurance from a former employer or Medicaid, or from a an insurance policy you buy in the individual market, which is sometimes called a Medigap policy.
However, if you don’t buy a Medigap policy when you first enroll in Medicare, you could end up locked into a Medicare Advantage plan.
What are your rights to buy a Medigap policy?
- When you first enroll in Medicare at 65 or later, you have the right to buy a Medigap policy of your choosing, regardless of your age or health, for six months during your initial enrollment period. You should buy the policy when you enroll in traditional Medicare to minimize your out-of-pocket costs.
- If you enroll in a Medicare Advantage plan when you are first eligible for Medicare at 65 or later, you have the right to buy a Medigap policy if you switch to traditional Medicare within 12 months, up to 63 days after you leave your Medicare Advantage plan.
- If you are enrolled in traditional Medicare with a Medigap policy and drop that policy to enroll in a Medicare Advantage plan, you have the right to get that Medigap policy back if you disenroll from your Medicare Advantage plan within 12 months of joining, but you must apply for coverage no later than 63 days after you leave your Medicare Advantage plan.
- If you live in Massachusetts, Minnesota or Wisconsin, you always have the right to buy a Medigap policy but the insurer can charge you more based on your health status if you are not buying the policy during your initial enrollment period.
- In Massachusetts, Maine, Connecticut and Vermont, you always have the right to buy a Medigap policy and the insurer cannot charge you more based on your health status.
- If your Medicare Advantage plan leaves or you leave the area and you switch to traditional Medicare, you have a guaranteed right to buy a Medigap policy so long as you do so within 63 days of your Medicare Advantage plan coverage ending.
- If you have retiree coverage from a former employer that fills gaps in traditional Medicare and that coverage end, you have a guaranteed right to buy a Medigap policy.
- If your Medicare Advantage plan is found not to comply with its legal obligations or somehow misled you, you have a guaranteed right to buy a Medigap policy.
- If you are under 65 and have Medicare because you are receiving Social Security Disability Income, you have no guaranteed right to buy a Medigap policy under federal law.
There are a variety of standardized Medigap plans, some of which fill more gaps in coverage than others. To learn more about your Medigap options and how to choose a Medigap plan, click here.
Here’s more from Just Care:
- Four things to think about when choosing a plan to fill gaps in Medicare, a “Medigap” or Medicare supplemental insurance plan
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Well-kept secrets of Medicare Advantage plans
- Get the preventive care you need: Medicare pays for it
- 2021: Programs that lower your health care costs if you have Medicare
