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Medicare Advantage Switch? Beware Medigap Hurdles
11 Mar
Summary
- Medigap insurers can deny coverage based on health, a process called medical underwriting.
- Many Medicare Advantage plans are exiting markets, forcing members to seek alternatives.
- Guaranteed Medigap enrollment exists for specific situations and state-based exceptions.
Navigating the transition from Medicare Advantage (MA) to original Medicare presents significant challenges, particularly concerning Medigap supplemental insurance. As the current open enrollment season allows beneficiaries to switch plans, many discover that Medigap insurers can refuse coverage based on an applicant's health history through medical underwriting.
This issue is compounded by an increasing number of MA plans withdrawing from service areas. This trend forces enrollees out of their plans, creating a need to find alternative coverage. An estimated 10% of MA members may be displaced this year alone due to these market exits.
While federal law offers a one-time, six-month window for guaranteed Medigap enrollment upon initial Medicare Part B coverage, this protection often ends. Exceptions exist, including guaranteed enrollment in Connecticut, Massachusetts, and New York year-round, and a "trial right" allowing switches within the first year of MA enrollment.
Special enrollment periods are also available if an MA plan leaves the market or an enrollee moves out of a plan's service area. In these situations, beneficiaries can secure Medigap coverage without underwriting. State Health Insurance Assistance Programs (SHIPs) offer free guidance to navigate these options and insurer-specific rules.
