The Medicare Supplement Open Enrollment Period (OEP) allows one to maximize his or her efforts in securing a Medicare Supplemental Insurance Plan (Medigap).
During the OEP, applicants stand to gain several advantages that will result in getting the coverage needed in achieving secured retirement years, both for health and financial issues that one may face.
As such, we’re compiling several key pointers on the OEP today. We hope that by providing this reference material, we’d be able to motivate you and other readers on taking advantage of the Medigap OEP.
After all, everyone deserves a brighter future – and everything begins during the OEP!
Medicare Supplement Open Enrollment Period Details
What is the Open Enrollment Period for Medicare Supplements? The OEP, a six-month period when private insurance companies cannot implement a medical underwriting procedure, allow applicants to have an easier and seamless enrollment process when selecting and purchasing a Medigap policy (even if the applicant has any health problems).
Medigap OEP Eligibility Details
To be eligible, you must:
- Be 65 or older
- Be enrolled in Medicare Part B
The OEP automatically begins when both factors above are met. Once the OEP begins, it cannot be delayed or replaced.
Purchasing a Medigap policy outside the OEP may lead to limited options and may even cost more. Some states have additional open enrollment periods. Applicants must consult with their agents regarding this matter.
Let’s further illustrate different scenarios when enrolling during the Medigap OEP.
|The applicant is 65 or older||The OEP begins once the applicant enrolls for Part B coverage. However, the rule of thumb is to enroll for Part B coverage once the applicant is first eligible, to avoid late fees and the like.|
|The applicant is turning 65||The best time to purchase a Medigap plan is during the six-month period that begins on the first day of the month that the applicant turns 65. Applicant must be enrolled in Medicare Part B too.|
|The applicant is under 65||Certain states offer an open enrollment period for individuals under the age of 65. As per Senate Bill 42 (SB 42), private insurance companies that offer Medigap policies to individuals 65 and older must also offer the same plans to anyone under the age of 65 who qualifies for Medicare, mainly due to a disability.|
|The applicant has group health coverage through an employer or union||Applicants may want to wait to enroll in Part B is he or she is part of group coverage. This is because benefits offered by employer plans are similar to Medigap policies.
When employer coverage ends, applicants get a chance to enroll in Part B without a late enrollment penalty. The Medigap OEP will then start once the applicant has enrolled in Part B.
Medigap OEP Benefits
Regarding the advantage of the OEP, enrolling during this period allows applicants these benefits:
- A private insurance company cannot refuse to sell you any Medigap policy it offers.
- A private insurance company cannot charge you a higher premium than they charge others who are 65 and older or have health conditions.
- A private insurance company cannot delay the start of your Medigap coverage.
Do take note that even though Medigap coverage cannot be delayed during the OEP, private insurance companies may still make applicants wait for cases linked to a pre-existing health condition.
Medigap OEP Pre-Existing Condition Waiting Period
Essentially, a pre-existing condition is a health problem that an applicant has before the date a new insurance policy begins.
For private insurance companies that have pre-existing waiting periods, these companies can refuse to cover for out-of-pocket health care costs related to the applicant’s health condition for up to six months.
Also, coverage for a pre-existing condition can only be excluded in a Medicare Supplemental policy if the said condition was treated or diagnosed within six months before the date the coverage begins.
It is also possible to shorten (or even avoid) the Medigap pre-existing waiting period. In order to so, an applicant must meet all of the following points:
- You must buy a Medicare Supplemental Insurance Plan during your open enrollment period.
- You are in the process of replacing creditable health coverage.
- You have had at least six months of continuous prior creditable coverage.
- You must and did not have a break in coverage for more than 63 days.
Purchasing a Medigap policy that has a guaranteed issue right also means that a private insurance company cannot enforce the pre-existing waiting period.
What Are Guaranteed Issue Rights?
Also called as Medigap protections, guaranteed issue rights are a set guideline of rights individuals have in certain scenarios then private insurance companies must provide Medicare Supplement Policies. Private insurance companies must provide the following:
- They must sell the applicant a Medigap policy.
- They must cover all of the applicant’s pre-existing health conditions.
- They cannot charge a higher premium for a Medigap policy because of the applicant’s past or present health problems.
Here are the guaranteed issue rights for individuals with pre-existing health conditions and disabilities:
- The applicants is enrolled in a Medicare Advantage Plan, and the plan is leaving Medicare or stops giving care in the applicant’s area, or the applicant moves out of the plan’s service area.
- The applicant was in an employer health plan that terminated coverage.
- The applicant joined a Medicare Advantage plan when he or she first becomes eligible for Medicare at age 65 and leaves the plan within one year.
- If the applicant drops a Medigap policy to enroll and join in a Medicare Advantage plan for the firsttime and the applicant leaves within one year of
- If the applicant leaves a plan because of failure to meet its obligations to the policyholder.
- If the applicant’s Medigap insurance company goes bankrupt and the applicant loses coverage, or the Medigap policy coverage ends through no fault of the applicant’s own.
Additionally, the terminating or previous plan/insurer needs to provide written documentation as proof of coverage to the new plan.
I’m Confused. What is the Medicare Open Enrollment Period?
A common mistake that most fall into is considering a Medigap Open Enrollment Period the same as the Medicare Open Enrollment Period – this shouldn’t be the case, for the two events are different and separate from each other.
The Medicare Open Enrollment Period (Annual Election Period) occurs every October 15 to December 7 of each year. During this period, Medicare policyholders can switch to other Medicare insurance plans or sign up for additional coverage.
As a helpful reminder, have these in mind:
- Medicare Open Enrollment Period: set period every year.
- Medigap Open Enrollment Period: happens only once in a person’s lifetime.
Knowing the difference can save you the time and trouble of learning which benefits apply on each OEP.
Additional Medigap Information You Need to Know About
Here are other pointers to help wrap your head around the Medicare Supplemental OEP.
About Medicare Part B
Medicare Part B covers services and supplies that are medically necessary to provide treatment for a policyholder’s health condition.
For services, Part B covers the following:
- Medically Necessary Services – services concerning the diagnosis or treatment of a medical condition.
- Preventive Services – health care to prevent the onset of diseases or the like.
Here are some examples of supplies covered by Part B:
- Durable Medical Equipment (DME)
- Ambulance Services
- Clinical Research
Individuals who are not receiving retirement benefits before the age of 65 may need to sign up for Medicare Part B. If you need to enroll, please do so during the Initial Enrollment Period (IEP), a seven-month period that begins three months after an individual turns 65.
Doing so will prevent Part B late enrollment fees to be applied.
Medigap for Individuals Under the Age of 65
As mentioned above, several states that may allow private insurance companies to sell Medicare Supplements to individuals under the age of 65. It is suggested for applicants to consult with their insurance agents regarding this matter.
|North Carolina||* A Medigap plan cannot be offered to people with End-Stage Renal Disease|
Enroll for Coverage Today
We hope that the information posted above will give you a good perspective on how to prepare for your future. Aside from aiming for enrollment during the Medicare Supplement Open Enrollment Period, consider requesting for Medigap quotes online as well. Doing so will give you the advantage to compare premium rates or quotes.
Good luck on your journey! Also, please let us know if you have any questions about the Medigap OEP or if you have other tips or suggestions to share by leaving a comment below.