Rights with Medigap

People who purchase a Medigap policy have certain rights. These rights can protect you from being denied coverage. They also can protect you from having to keep a plan that is not right for you. If you are thinking about buying a Medigap, or if you already have one, keep these tips in mind.

Free Look Periods

By law, when you buy a Medigap policy, you have a 30-day “free look,” or trial period.  If you change your mind within 30 days of the day your policy started, you can cancel it and get a refund.

If you are switching Medigap plans, do not cancel your first policy until after your free look period is up. You may have to pay two premiums for one month. But you will be able to change back to your first plan if you need to.

Pre-Existing Condition Wait Periods

If you do not have health coverage in the months before you want to buy a Medigap, you may have to wait to be covered for certain health conditions. This is called a pre-existing condition wait period. It can last up to 6 months, depending on how many months you did not have coverage as good as Medigap, also called “creditable coverage.”

For example, a person with no creditable coverage:


medigap-rights-3monthFor example, a person with 3 months of creditable coverage:


medigap-rights-3monthFor example, a person with 6 months of creditable coverage:


medigap-rights-no-wait-periodConfused about whether you will be covered?  Get personal help to sort it out.

Renewals

As long as you pay your Medigap premium, the company renews your policy automatically each year. This means that your coverage continues year after year as long as you pay your bill. Your policy is what is called “guaranteed renewable.”

Other Protections

Your state decides some of the rights and protections for people with Medigap policies. Protect yourself by keeping copies of any letters, notices, emails, and claim denials from your Medigap insurance company that have your name on them.

Keep any postmarked envelopes that these papers came in. Also, keep any papers that prove the date you bought your new Medigap policy. You may need this paperwork later if you have a problem with your plan.

To find out more about your state's rules and your rights, use the state insurance department locator.

Questions You May Want to Ask Your State Insurance Department

  • Does the law require Medigap insurance companies to sell to people who are under age 65 and have disabilities?
  • What is the most number of months a Medigap insurer can make me wait for coverage of a pre-existing condition?
  • Are there Medicare Select policies in my state? If so, is my doctor in the provider network?
  • Which companies are licensed to sell Medigap in my state?

Also, if you live in Massachusetts, Minnesota, or Wisconsin, you will need to ask what plans are available there. If you need help finding this information, get personal help.

Solving Problems with Your Medigap Plan

Your first resource for solving problems with your plan is your Medigap insurance company.  By law, they must give you information on your rights. They may also have a customer service phone number you can call.  Check your plan's benefits booklet for this contact information.

If you need help working with your insurance company, get personal help. This way, you can get connected to someone who knows the laws in your state.

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