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Open enrollment periods are when an insurer must issue a policy despite the insured's condition

Open enrollment exists when you meet certain conditions under age 65 and others at age 65 and older.

There are also opportunities for coverage even if no Open Enrollment period is available. 

For information about these subjects, see

NOTE: The Pre-Existing Condition Insurance Plan (PCIP) makes health coverage available to you if you are a U.S. citizen or reside here legally, you have been denied health insurance because of a pre-existing condition, and you have been uninsured for at least six months.  For information about your state, click here offsite link.

Open Enrollment For Medigap Plans For People Under Age 65 Who Are On Medicare

There is no federal law that requires insurance companies to sell Medigap coverage to people under age 65. However, some states have passed legislation that requires insurance companies to offer at least some plans for people under age 65 who have Medicare because they are disabled.

Check with your state Department of Insurance for your state's most current laws. For contact information for your Department of Insurance, see: offsite link.

Open Enrollment For Medigap Plans For People Age 65 And Older

The federal government requires insurance companies writing Medigap policies to allow Medicare beneficiaries to enroll during an open enrollment period that begins on the first day of the month that you are both:

  • Age 65 or over (Medicare considers your age to change the day BEFORE your birthday, so if your birthday is on the first of the month, for Medicare purposes you will turn 65 the month before your birthday) and
  • You are enrolled in Medicare Part B.

If you purchase a Medigap policy during an open enrollment period, the carrier must:

  • Accept you for coverage regardless of your health condition or medical history.
  • Not adjust the rates based on your health or medical history.
  • Credit any pre-existing conditions waiting period (which can be up to six months) with time you spent covered under another plan, including Medicare, which ended within 63 days of the effective date of the Medigap coverage. (To learn more, see Pre-Existing Conditions Waiting Period below.)

If you already have other health coverage when you turn age 65 so you don't need Part B or a Medigap policy, you may decline Part B, effectively postponing your Medigap open enrollment period. If you later lose your other insurance, or if you enroll in Part B during the annual open enrollment period, you will have your open enrollment for Medigap coverage available to you.

The Medigap open enrollment period lasts for six months. For example, you turn 65 on May 15 and you enrolled in Parts A and B during April. Your Medicare becomes effective on May 1.Your open enrollment period for Medigap will last for 6 months from May1 through October 31.

If you have coverage from an employer or your spouse's policy, you may protect your right to an open enrollment in a Medigap plan at a later date by declining Part B Medicare initially. See Medicare -- Advice -- Enrollment for more information on declining Part B Medicare.

Other Opportunities To Enroll In Medigap Without Medical Underwriting

In some state, such as New York, you can obtain Medigap insurance without limitation.

In all states, there are some other occasions when an insurance company must offer Medigap coverage without regard to your health or medical history:

If you enrolled in a Medicare Managed Care Plan or Medicare SELECT (see below) when you first became eligible for Medicare and you choose to leave the Medicare Managed Care Plan or Medicare SELECT plan within one year after joining.

If both these factors occur:

  • You have the right to purchase any Medigap policy available in your state, provided you purchase the Medigap policy within 63 days of leaving the Medicare health plan.
  • The Medigap policy cannot require medical underwriting
  • The Medigap policy must cover all pre-existing conditions
  • The insurer cannot charge you more because of your existing medical condition or health history.

If you dropped a Medigap policy to join a Medicare Advantage plan or a Medicare SELECT policy for the first time and then leave the plan within one year of joining.

You have the right to return to your former Medigap policy from the same insurance company provided you apply no later than 63 days after the Medicare health plan coverage ends. (Notice that the key here is 63 days after you apply. It is not tied to the date of issue of the Medigap policy.)

If your former policy is not available, you have the right to buy Medigap plans A, B, C, or F (whichever are sold in your state) as long as you apply within 63 days after your Medicare health plan coverage ends.

You cannot be denied coverage, have a pre-existing conditions waiting period imposed, or be charged more due to your medical condition.

If your Medicare health plan or your current Medigap policy ends, you may have the right to purchase a Medigap policy in certain circumstances.

If your Medicare health plan or your current Medigap policy ends, you have the right to purchase a Medigap policy if any one of the following occur:

  • Your Medicare health plan stopped participating in Medicare or giving care in your area.
  • You move outside the plan's service area.
  • You leave the health plan because it failed to meet its contract obligations to you.
  • You were in an employer group health plan that supplemented or was a secondary payer to Medicare (see Medicare -- Coordination of Benefits), and the plan ends your coverage.
  • Your Medigap policy or Medicare SELECT policy ends, and you're not at fault (such as the company goes bankrupt).

In these cases you must be allowed to purchase Medigap plans A, B, C, or F - whichever are sold in your state:

  • Without medical underwriting.
  • Without imposing a waiting period for pre-existing medical conditions.
  • Without charging more because of your medical history.

In most cases, you must stay in your health plan until the date your coverage ends. If you leave the plan before the announced termination date of your coverage, you may lose your right to guaranteed Medigap coverage.

If There Is No Open Enrollment That Applies To You

If there is no open enrollment period that applies to you, a Medigap insurance carrier may:

  • Require proof that you are insurable before accepting you for Medigap coverage. This means that a company can refuse to sell you a Medigap policy because of your health history.
  • Sell you a policy, but impose a waiting period of up to six months for health conditions for which you got medical treatment or advice within the six months before the date that the new Medigap insurance policy took effect.

If the insurer imposes a waiting period, credit must be given against the waiting period for any time spent in a health plan which ended less than 63 days before the Medigap coverage starts. For example, if you had health coverage for three months, and the gap between the two coverages is less than 63 days, the most amount of time Medigap can exclude coverage for an existing condition is 3 months. If you had prior coverage for 6 months or more, there cannot be any pre-existing condition waiting period. For more information, see HIPAA.

NOTE: Consider the alternative of purchasing a Pre-Existing Condition Insurance Plan (PCIP) which makes health coverage available to you if you are a U.S. citizen or reside here legally, you have been denied health insurance because of a pre-existing condition, and you’ve been uninsured for at least six months.  To learn about the availability in your state, premiums and other costs as well as benefits, click here. offsite link