Open enrollment rights mean that companies selling Medigap policies must sell you a plan without health screening. However, companies may impose a waiting period of up to 6 months for any health condition you had that was treated or diagnosed within 6 months before the date your Medigap coverage began. But if you had any health coverage, including Medicare, before purchasing a Medigap plan, the company must subtract those months from the waiting period.
For example, if you had coverage for only 3 months prior to purchasing a Medigap plan, the company must subtract 3 months from any waiting period that applies. A waiting period is limited to 6 months. Thus, if you had health coverage for 6 or more months before purchasing a Medigap plan, the company cannot impose any waiting period for pre-existing conditions.
Other Open Enrollment rights
In California, in addition to the Open Enrollment period following the effective date of your Medicare Part B, you also have the right to purchase a Medigap policy for 6 months following the events described below.
Event 1.
When you have employer-sponsored group health coverage through your own, your spouse’s, or a family member’s current employment or retirement plan, and the plan terminates, OR you lose your eligibility to continue benefits due to divorce or the death of a spouse or other family member. The 6- month period to apply for a Medigap policy starts on the date that you receive the notice that your health benefits will end. If you do not receive a notice in advance, then the 6-month period starts the date the benefits actually end, or the date of your first denied claim. This protection of California law applies regardless of whether your group health benefits were primary or secondary to Medicare.
You are also entitled to this protection when you have used up all the COBRA benefits for which you are eligible. For more information on COBRA, see our fact sheet “Medicare and Other Health Insurance Coverage” at cahealthadvocates.org.
Event 2.
When you move out of the geographic area served by your Medigap plan. For instance, if you have a Medigap you bought while living in another state that will not cover you in this state, you have 6 months to replace that policy without health screening.
Event 3.
When your health care coverage ends because of a military base closure, or because a military base no longer offers health care services, you move away from the base, or you are no longer eligible to receive health care services at that base.
Event 4.
When you lose your eligibility for Medi-Cal benefits because of an increase in your income or assets, or you are required to pay a Share of Cost before Medi-Cal will pay for your care.
Note: For the 4 events mentioned above, your choice of Medigap plans depends on your age. If you are 65 years old or older, you can choose from all of the Medigap plans that are available for sale from any company in your geographical area. If you are younger than 65 years old (and you do not have ESRD), you can choose A, B, C, or F. You can also choose H, I or J, or K or L, if the company sells any of those plans, but the company has the right to decide which of these plans it will sell you.
Before purchasing a Medicare supplement, visit Insuriffic.com to compare Medicare quotes.