Open Enrollment @ 65?

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Are You Turning 65?

The best time to purchase a Medigap policy, also known as a Medicare Supplement policy, is during your “open enrollment period”. Don’t get your open enrollment period confused with the Medicare‘s annual open enrollment period — Oct. 15 thru Dec. 7.  Federal law gives you a 6-month open enrollment period to apply for a Medigap insurance policy, beginning with the first month that you enroll for benefits under Medicare Part B.

Note: You can send in your application for a Medigap policy before your Medigap open enrollment period starts. This may be important if you currently have coverage that will end when you turn age 65 and will allow you to have continuous coverage.

The below information will help you understand your rights during Open Enrollment.

During your open enrollment period, an insurance company is not allowed to medically underwrite your policy. This means the insurance company can’t do any of the following:

 Refuse to sell you any Medigap policy it has available
 Make you wait for your coverage to start
 Charge you more for a Medigap policy because of any health conditions
 Make you wait for your coverage to start
 Charge you more for a Medigap policy

The insurance company can’t make you wait for your coverage to begin but they may be able to make you wait for coverage of a pre-existing condition. A pre-existing condition is a health condition you have before your Medigap insurance policy starts. In certain cases, the insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is called a “pre-existing condition waiting period.” Coverage for a pre-existing condition can be excluded from your Medigap policy if the condition was treated or diagnosed within 6 months before your new Medigap policy begins.

If you buy a Medigap policy during your Medigap open enrollment period and you recently had certain kinds of health coverage in place called “creditable coverage,” it is possible to avoid or reduce waiting periods for pre-existing conditions. Creditable coverage is generally any other health coverage you had before applying for a Medigap policy. If you’ve had at least 6 months of prior creditable coverage, the Medigap insurance company is not able to make you wait before it covers your pre-existing conditions.

There are several types of health care coverage that qualify as creditable coverage for Medigap policies, but they will only count if you didn’t have a break in coverage for more than 63 days. If there was any time that you did not have health coverage of any kind and you were without coverage for more than 63 days, you can only count the creditable coverage you had after that break in coverage.

If you buy a Medigap policy during a guaranteed issue period (also called “Medigap protection”), the insurance company can’t use a pre-existing condition waiting period at all.