Changing Medigap Policies
There are many reasons to switch Medigap plans. Maybe out-of-pocket costs are too high, certain benefits are unneeded, or health changes require additional coverage options. In most cases, there is no right under Federal law that allows switching Medigap policies unless eligible under a specific circumstance, guaranteed issue rights, or within the 6-month Medigap Open Enrollment Period.
Suspending Medigap Coverage if Employed
If enrolled in other health insurance, it is possible to hold or suspend a Medigap policy. Suspension can occur under the following circumstances:
Returning to work with employer coverage under age 65, previously enrolled in Medicare and had a Medigap policy, or
The dependent, spouse or adult child of someone who gets a job that offers health insurance.
This right to suspend a Medigap policy if receiving employer health insurance is only for people with Medicare and Medigap who are not yet 65. Be sure to contact the Medigap insurance company and notify them of suspension. Medigap can be suspended at any time while covered under employers group health insurance, and if Medicare-eligible due to a disability.
If employer health insurance coverage is lost, re-enrollment in Medigap is allowed. Contact the Medigap company and let them know within 90 days of losing employer coverage and Medigap coverage will begin the day it is lost.
New to Medicaid, Suspending Medigap
Medigap policies can be put on hold, or suspend it, within 90 days of getting Medicaid. Send the company a letter to suspend the policy, they will be able to provide more information on next steps.
Medigap policies can be suspended for up to 2 years. Some people choose to keep their Medigap policy active so they can see doctors that do not accept Medicaid. This can be expensive and should be considered carefully.
If already on Medicaid, an insurance company cannot by law sell a Medigap policy except if:
Medicaid pays the Medigap premium, or
Medicaid only pays all or part of the Medicare Part B premium.
Switching from Medigap to a Medicare Advantage plan
Medigap policies can’t work with Medicare Advantage Plans. A Medigap policy cannot be used to pay Medicare Advantage Plan copayments, deductibles and premiums. It is best to drop Medigap if enrolling in a Medicare Advantage Plan (Part C).
If there is a switch from an MA plan back to Medigap in the future, returning to the same or any policy may not be possible without a “trial right” or “guaranteed issue” right. Generally, these rights are only during the first 12 months of enrollment in a Medicare Advantage plan.