“You need to check your facts. I think you are wrong!”
This afternoon I had an older real estate agent tell me that he knows more about Medigap than I. I must admit, that it is not unusual for someone to have more knowledge about a topic than me.
However, I have been working with insurance for more than 25 years. I know what can and cannot be done. Earlier this year I shared the importance of getting Medigap if you want it when you are first eligible in, “Why Is It Important To Buy Medigap When I Am First Eligible.”
This man’s concern is a bit different. He got Medigap when he was first able to but is not happy with the insurance company he chose at that time. He is working under the false assumption that he can change insurance companies any time he wants, regardless of his health.
Insurance is like a river. It is constantly changing. It is dangerous to try to navigate the river of insurance unless you know what it is currently like. Assumptions you make based upon what was true a few years ago are not always correct under new laws.
This individual insists that he is allowed to switch Medigap plans without any medical underwriting. That is not the case but I can understand how he can get confused.
ADVANTAGE IS NOT MEDIGAP
For the past several months seniors have been bombarded with advertisements talking about their ability to switch Medicare Advantage plans.
Each year a person on Medicare is permitted to change their Medicare Advantage elections regardless of their health. If they elect that option, they have a 6 week window in which they must request the change for the following year. In 2012, that window was October 15 – December 7.
With all the changes to Medicare Advantage that happened with the Patient’s Protection and Affordable Care Act, the only Advantage plans that will be able to enroll people outside of that window are those who have obtained a 5 Star Rating from the Department of Health and Human Services. As of now, you could probably count on your fingers the number of plans in the nation that have earned that coveted rating.
Medigap, however, is different. Advantage plans replace Original Medicare. Medigap plans supplement Original Medicare.
There are a handful of occasions when the insurance company is required to approve your application for Medigap regardless of your health. The first is called your Open Enrollment Period or Initial Election Period. That period is usually around your 65th birthday. You can read more details about it on page 14 of Choosing A Medigap Policy.
The only other times that Medigap insurance is guaranteed to be approved is during a Special Election Period. There are only a handful of circumstances that qualify for one of Medicare’s Special Election Periods. You can read more about them starting on page 21 of Choosing A Medigap Policy.
If you do not qualify for either the Initial Enrollment Period or a Special Enrollment Period, you can still change your Medigap policy from one insurance company to another but you must be able to pass their medical underwriting requirements.
Most insurance companies are pretty lenient with their requirements. They understand that the average person on Medicare tends to have more health problems than the average person who is still covered with private health insurance.
If you are being treated for a routine condition such as elevated blood pressure or cholesterol, don’t be afraid to submit your application for Medigap to a different insurance company if that is what you want to do.
Just do not cancel what you have until after you have gotten a new policy from the new insurance company.
Remember, the submission of an application is not the same thing as a policy being issued. To avoid the temptation to accidentally cancel a current plan, always request and effective date for new coverage at least 30 days in the future. That should give the insurance company plenty of time to either approve your new policy or explain any delays.
For more information about Medicare visit Medigap Advisors.