Key takeaways

  • You can switch Medigap plans without medical underwriting during the 6-month Medigap open enrollment period or within the 30-day “free look period” after enrolling in a new plan.
  • Depending on your state, you may be able to switch Medigap plans without medical underwriting due to certain guaranteed issuer rights, which prevent insurers from denying you a policy in certain situations.
  • Switching Medigap plans may affect coverage for preexisting conditions if you have been on your current policy for fewer than 6 months, potentially requiring you to wait for coverage under the new policy.

Medigap (Medicare supplement) policies are supplemental insurance plans administered by private health insurers. The insurers have a process they use to decide whether to offer coverage and what to charge based on your health status.

This process is called medical underwriting, and it means that Medigap plans can deny you enrollment based on pre-existing conditions. If they approve enrollment, they may deny coverage for out-of-pocket costs stemming from medical care related to pre-existing conditions or charge higher premiums.

That said, a Medigap insurer cannot deny you either enrollment or coverage through medical underwriting during your 6-month Medigap open enrollment period and in certain other specific situations. Read on about the rules of switching Medigap plans without medical underwriting.

Most of the time, you can only switch Medigap policies without going through medical underwriting if you’re still within your 6-month Medigap open enrollment period, which begins the first month you’re 65 or older and enrolled in Medicare Part B. This means the Medigap insurer cannot deny you coverage or enrollment if you enroll during this window of time.

If you decide to try a new Medigap policy, you get a 30-day “free look” period to decide if you want to keep it. This 30-day clock starts when you receive the new policy. During this time, it may be a good idea to keep the former policy and pay its premium in case you decide you wish to switch back.

After these 30 days, if you’ve had your Medigap policy for less than 6 months and want to switch, the new policy may require medical underwriting, and you may get denied enrollment or coverage for costs related to certain pre-existing conditions.

In addition to switching Medigap plans during your Medigap open enrollment period, you may be able to switch plans without medical underwriting at other times.

Your state may have guaranteed issuer rights. These are additional situations in which the insurer can’t deny you a policy. These may include:

  • Your Medicare Advantage (Part C) plan is no longer available.
  • You have Original Medicare (parts A and B), but also a private employer plan that’s ending.
  • You have Original Medicare and Medicare Select, but you move out of the latter’s service area.
  • You joined Medicare Advantage or the Program of All-Inclusive Care for the Elderly (PACE) but now want to switch to Original Medicare within the first year.
  • It’s been less than a year since you joined a Medicare Advantage plan or switched to Medicare SELECT.
  • Your current plan’s administering company goes bankrupt, or you lose coverage for other reasons not in your control.
  • You leave a Medicare Advantage plan or Medigap policy due to rule violations or misleading information.

The rules for enrolling in a Medigap plan without medical underwriting depend on your state. Some states offer more protections than the federal minimum.

For instance, in California, you can switch plans or insurance companies around your birthday without going through medical underwriting.

In Connecticut, Massachusetts, Maine, and New York, insurers must let you buy a Medigap plan at any time of the year, as long as you’re 65 or older, without requiring medical underwriting.

Medigap plans are standardized across all U.S. states, with the exception of Massachusetts, Minnesota, and Wisconsin. There are 10 different plans to choose from, offering different levels of coverage.

Reasons you may wish to switch your Medigap policy include:

  • You’re paying for benefits that you don’t need
  • You need more benefits than what you’re getting.
  • You want to switch insurance companies.
  • You want to lower your costs.

If you decide to switch Medigap policies, it’s best to look at the specific plans and research the specific guidelines and rules in your state.

Medigap vs Medicare Advantage

Medigap plans aren’t the same as Medicare Advantage (Part C) plans. Medigap is meant to help cover your out-of-pocket costs, while Medicare Advantage plans are private medical insurance options that replace Original Medicare.

You can only use a Medigap plan with Original Medicare, but if you drop a Medigap plan to try an Advantage plan for the first time, you get a one-time, 12-month “trial right.”

During this period, you can return to Original Medicare and get your old Medigap policy back without medical underwriting, as long as the same insurer still sells it.

If it’s no longer available, depending on your state’s rules and whether you first enrolled in Medicare on or after January 1, 2020, you may qualify to buy a different Medigap plan.

Medigap plans are private insurance policies that help you pay for costs that Original Medicare doesn’t cover, such as deductibles or coinsurance.

Insurers usually use medical underwriting to decide if you qualify and what your premium will be. This can mean being denied enrollment, facing limits on coverage for preexisting conditions, or paying higher premiums.

However, during your 6-month Medigap open enrollment period, and in certain situations where you have guaranteed issue rights, insurers cannot deny you coverage.