Q & A: September 2018

Q & A: September 2018

Q: When I enrolled in Medicare two years ago I purchased a Medigap “F” supplement.  Since then, my premiums have gone up 15% a year!  I’m worried that I won’t be able to sustain cost increases like that for long.  Am I allowed to switch to a lower-costing supplement? 

A: Even though the 2010 Affordable Care Act forbids health insurers from refusing to cover you, or charging you more due to “pre-existing” conditions — that protection does not extend to Medicare supplements. If you have owned your Medigap policy for more than 6 months, in most (but not all) cases you won’t have a right to “guaranteed issue.”  When you have this right, companies must sell you a Medigap policy at the best available rate, regardless of your health status, and cannot deny you coverage.

Under federal law, Medigap insurers can refuse to cover your prior medical conditions for the first six months.  You may have a guaranteed issue right, however, if one of the following applies:

  • You lost a group health plan that covered your Medicare out of pocket, through no fault of your own.
  • You were enrolled in a Medicare Advantage Plan when you first became eligible for Medicare and disenrolled within 12 months.
  • Your previous Medigap policy, Medicare Advantage Plan or PACE program ends it coverage or commits fraud.

Should you find a company that agrees to sell you a policy, you may be charged a higher monthly premium and be subject to a six-month waiting period before the policy will cover pre-existing conditions.  Contact Medigap insurers in your state to learn if they will sell you a policy outside the protected period.

Very important! Should you get a new Medigap supplement, don’t cancel your old policy right away.  You have a right to review a new Medigap policy for the first 30 days.  You may cancel within that time for a full refund if it does not meet your needs.  You will however, be responsible to pay premiums for both policies during this 30-day “free look” period.

Premiums for Medigap supplements are one of the fastest growing costs of retirees who have that type of coverage — increasing 16% on average from 2017 to 2018.  Premiums are on the fast track upward after Congress enacted legislation in 2015 that will close Plan F and C to new enrollees in 2020.  While people who currently own one of these policies will be able to keep it, closing the policies to younger and more healthy new enrollees will mean that those left will be older, sicker and more expensive to insure, thus driving up premiums.


To learn more:

Use this tool to answer your questions — Medicare Interactive by the Medicare Rights Center — https://www.medicareinteractive.org


To get questions answered by phone or in person:  Free one-on-one insurance counseling from your State Health Insurance Assistance Program (SHIP).  Find a counselor in your area here: https://www.shiptacenter.org