Dear Marci,
My mother is 66 and has Original Medicare. She would like to purchase a Medigap policy. When can she do that?
-Gale (Tacoma, WA)
Dear Gale,
Medigaps are health insurance policies that offer standardized benefits to work with Original Medicare (not with Medicare Advantage). They are sold by private insurance companies. Medigaps pay for part or all of certain remaining costs after Original Medicare pays first.
If your mother wants to purchase a Medigap policy, she needs to find out the best time to buy one in her state. In most states, insurance companies must only sell someone a policy at certain times and if they meet certain requirements. If your mother misses her window of opportunity to buy a Medigap, her costs may go up, her options may be limited, or she may not be able to buy a Medigap at all.
Under federal law, your mother has the right to buy a Medigap policy if she:
- Is 65 or older and enrolled in Medicare
- And, she buys her policy during a protected enrollment period. The two kinds of federally protected enrollment periods are:
- Open enrollment period: Under federal law, your mother has a six-month open enrollment period that begins the month she is 65 or older and enrolled in Medicare Part B.
- Guaranteed issue right: Your mother has a guaranteed issue right within 63 days of when she loses or ends different kinds of health coverage.
At times when your mother has the guaranteed issue right to buy a Medigap policy, an insurance company cannot:
- Deny her Medigap coverage
- Or, charge her more for her a policy because of past or present health problems.
Before your mother buys a Medigap, check to see if her state offers additional protections. Some states have expanded Medigap enrollment rights. Residents of New York and Connecticut, for instance, can buy a policy at the best available rate throughout the year, and Medigap insurers cannot deny coverage. If someone in a state without these additional protections wants to purchase a Medigap outside of a protected period, a Medigap insurer can refuse to sell them a policy. Depending on your mother’s age or health conditions, she may have trouble purchasing a Medigap policy outside of a protected period. You or she should call her State Health Insurance Assistance Program (SHIP) or Department of Insurance to learn more about her right to purchase a Medigap policy in her state. If you don’t know how to contact her SHIP, call 877-839-2675 or visit www.shiptacenter.org.
Even if your mother is not in a protected period to purchase a Medigap in her state, she may still be able to buy a policy if a company agrees to sell her one. However, know that companies can charge her a higher price because of her health status or other reasons.
-Marci