by Russell Noga | Updated January 18th, 2024
Are you looking to join a Medigap scheme with a private healthcare insurer? You have plenty of options for plans and carriers, but how do you enroll in Medigap? What if you missed the open enrollment period in the six months after your birthday, or you’re switching from Medicare Advantage to Medicare and Medigap?
The Medicare supplement special enrollment period can help you get a Medigap policy without the need to undergo medical underwriting. If you have to endure medical underwiring with a carrier, they might refuse your application or charge you higher-than-average premiums if you have a pre-existing condition.
There are two Medicare Special Enrollment Periods (SEPs). During these times, you can switch plans or providers or sign up for a policy outside of the standard enrollment periods.
- SEP – Qualifying Life Events: Two months.
- SEP – Working Past age 65: Eight months.
For seniors who had previous creditable healthcare coverage with an employer or union, you have an eight-month window to enroll in Medicare Parts A, B, C & D.
For seniors with Medicare Parts A, B, C, or D, and experience qualifying life events, there’s a two-month SEP to switch from a Medicare Advantage or Part D plan.
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The Standardized Benefits Available with Medicare Supplement Plans
Why sign up for Medigap instead of Medicare Advantage? Why do you need a Medicare supplement plan in the first place? Medigap policies cover the 20% of out-of-pocket costs involved with hospitalization and medical care not paid by Original Medicare Parts A & B.
All Medigap plans offer the following benefits.
- Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
- Part A hospice care coinsurance or copayment.
- Part B coinsurance or copayment.
- Blood transfusion costs for the first three pints of blood.
Plans F*, G, and N offer additional Medicare Parts A & B benefits.
- Part A deductible.
- Part B excess charges (Plan N doesn’t cover these charges).
- Skilled nursing facility care coinsurance.
- 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
- Unlimited coverage for all out-of-pocket costs.
*Plan F is available to seniors eligible for Medicare before January 1, 2020.
The Special Enrollment Period for Medicare Part B
If your healthcare coverage is through your employer or your partner’s employer, the Part B SEP permits the delay of taking a Part B policy without incurring penalties. You have up to eight months to enroll in Medicare Part B when the employer’s coverage stops.
To qualify for the Medicare Part B SEP, you’ll need credible healthcare coverage with an employer group healthcare plan when you’re first eligible for Medicare.
Or you’ll need to be eligible for Original Medicare due to a disability. Once the eight-month period ends, you no longer qualify for the SEP.
What is the Special Enrollment Period "Trial Period"?
You get a 12-month “Trial Period” when enrolling in a Medicare Advantage plan. Also known as “Part C,” Medicare Advantage replaces Original Medicare Parts A & B. You can switch to Original Medicare and take a Medigap plan as supplemental insurance in the Trial Period SEP.
This SEP gives the beneficiary a guaranteed issue right to Original Medicare and Medigap policies, and you don’t have to undergo medical underwriting when applying, even if you have pre-existing health conditions.
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Qualifying for Special Election Periods When Moving
Your current Medicare Advantage or Medigap plan might be unavailable if you move to a new state. As a result, you have a two-month window to enroll in a new plan. This period starts when you move or when you notify your provider of your move.
Your Medigap premium may increase or decrease depending on where you move, but your coverage stays the same. However, if you move to Massachusetts, Minnesota, or Wisconsin, these states have different rules surrounding Medigap policies.
What Are the Criteria for Switching Plans in the Medicare Special Enrollment Period?
Original Medicare beneficiaries qualify for a two-month SEP with certain qualifying life events. This SEP allows the beneficiary to switch to a different Part D plan or Medicare Advantage plan in the following scenarios.
- Your plan closes.
- Your plans stop servicing the area where you live.
- You move out of the plans service area.
- Your plan receives low star ratings.
- You enroll in a 5-star plan or drop your Medicare Advantage plan within a year of enrolling.
- You move into or out of a nursing home or qualifying institutional facility.
- You lose eligibility to or are enrolled in a State Pharmaceutical Assistance Program.
- You have financial assistance such as Medicare Savings Program, Extra Help, or Medicaid.
- You lose eligibility for a Medicare Savings Program, Extra Help, or Medicaid.
- You leave or enroll in the Program of All-Inclusive Care for the Elderly (PACE).
- You lose eligibility or gain eligibility for a Special Needs Plan.
There are other scenarios not listed above where you might qualify for a SEP.
If you leave your Medicare Advantage Plan within 12 months of enrolling, you can enroll in Original Medicare. You’ll also receive a SEP to purchase a Medigap plan without undergoing medical underwriting.
If your employee-sponsored healthcare plan offers benefits but ends supplemental coverage, you have two months to enroll in a Medicare Advantage or Medigap plan.
If your Medicare Advantage plan reduces your benefits, increases your premiums or copayments by 15% or more, ends its relationship with your provider, or stops offering the plan, you have two months to enroll in Medicare Advantage or Medigap.
How Do You Know If You Qualify for SEP?
You may be eligible for a SEP if you change or lose coverage. Beneficiaries with Extra Help, Medicaid, or other finical assistance programs may be eligible for additional SEPs allowing plan changes. Beneficiaries with chronic health issues are eligible to enroll in a Medicare Advantage Special Needs Plan at any stage during the year. Qualifying for a Medicare Advantage Special Needs Plan is a form of SEP.
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Frequently Asked Questions
What is the Medicare Supplement Special Enrollment Period?
The Medicare Supplement Special Enrollment Period is a specific period during which you have guaranteed issue rights to enroll in a Medicare Supplement plan without medical underwriting. This period typically occurs when certain qualifying events happen, such as losing your existing coverage or moving to a new area.
When can I qualify for the Medicare Supplement Special Enrollment Period?
Qualifying events that may trigger the Medicare Supplement Special Enrollment Period include losing your existing coverage (e.g., employer-sponsored plan or Medicaid), moving to a new area outside a Medicare Advantage plan service area, or your Medicare Advantage plan discontinuing service in your area.
What are guaranteed issue rights during the Special Enrollment Period?
Guaranteed issue rights during the Medicare Supplement Special Enrollment Period mean that insurance companies cannot deny you coverage or charge you higher premiums based on your health condition or pre-existing conditions. They must offer you any Medicare Supplement plan they sell during this period.
Can I choose any Medicare Supplement plan during the Special Enrollment Period?
Yes, during the Medicare Supplement Special Enrollment Period, you have the flexibility to choose any Medicare Supplement plan available in your area. This includes popular plans like Plan G and Plan N, as well as other lettered plans offered by insurance companies.
What is the difference between Medicare Plan G and Plan N during the Special Enrollment Period?
Medicare Plan G and Plan N offer different coverage benefits. Plan G provides more comprehensive coverage, including coverage for Medicare Part A and B deductibles, excess charges, and skilled nursing facility coinsurance. Plan N has cost-sharing requirements, such as copayments for certain services. The difference in coverage helps determine the cost difference between the two plans during the Special Enrollment Period.
Can I switch between Medicare Plan G and Plan N during the Special Enrollment Period?
Yes, during the Medicare Supplement Special Enrollment Period, you can switch between Medicare Plan G and Plan N or any other Medicare Supplement plan. This is an excellent opportunity to reassess your coverage needs and compare the benefits and costs of different plans to make an informed decision.
How long does the Medicare Supplement Special Enrollment Period last?
The duration of the Medicare Supplement Special Enrollment Period can vary depending on the qualifying event. In most cases, you have a window of 63 days from the date of the event to enroll in a Medicare Supplement plan without medical underwriting.
What happens if I miss the Special Enrollment Period?
If you miss the Medicare Supplement Special Enrollment Period, you may still be able to apply for a Medicare Supplement plan, but you will no longer have guaranteed issue rights. Insurance companies can subject you to medical underwriting, which may result in higher premiums or even denial of coverage based on your health status.
Do I need to provide proof of my qualifying event during the Special Enrollment Period?
Yes, during the Medicare Supplement Special Enrollment Period, you may be required to provide proof of your qualifying event. This can include documentation such as a termination letter from your previous coverage or a utility bill as proof of your new address.
Where can I get assistance with enrolling during the Special Enrollment Period?
To navigate the Medicare Supplement Special Enrollment Period, you can reach out to one of our licensed insurance agents at 1-888-891-0229. We can provide personalized guidance, help you understand your options, and assist with the enrollment process to ensure you make the most informed decisions based on your unique circumstances.
Call Us for Advice on the Medicare Supplement Special Enrollment Period
If you need professional advice on SEPs and Medigap plans, call our agents at 1-888-891-0229. We’ll advise you on your SEP and guaranteed issue rights to get you enrolled in the Medigap plan of your choosing. Our team offers free consultations and quotes, and we’ll get you the best rates on any plan.
Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.