Joanne: When it comes to Medicare Supplements, we often discuss what you should know when you are trying to find coverage for the first time. But what does the process look like when you're trying to change that coverage that you already have? That is exactly what we will discuss in today's episode.

Cameron: Before we start, My name is Cameron Giardini, and together with my cohost, Joanne Giardini Russell, we operate Giardini Medicare, which is an independent insurance agency based out of Southeast Michigan. Now, although we are based in Michigan, we work virtually over the phone to directly help consumers in about 13 states find the right Medicare coverage for them.

If we do not work in your state, we will connect you with another trusted independent agent who will be able to help you find the coverage you want. We also have a free online course that is now available for you to register for, and you can do this to learn about hundreds of different Medicare topics by going online to gmedcourse.com

Joanne: Let's do an overview. But a reminder, if you need a general overview of what Medigap and Part D coverage is, make sure to listen to our Medigap versus Medicare Advantage episode from January 16th. We'll talk today about the different options you have for changing Medigap coverage. We'll discuss when you can make specific changes to that Medigap coverage.

We'll then discuss the process of actually changing coverage. How do you change from one Medigap plan to another? How do you change from Medigap coverage to Medicare Advantage coverage? And then how do you change your Part D coverage without changing your Medigap plan? Then, we'll recap everything at the end. 

Cameron: So option number one is changing from one Medigap plan to another, and we'll talk about the first option, Which is open enrollment when it comes to Medigap. So first off you can change Medigap coverage 365 days of the year. This means going from one to another There is not a set enrollment period to change Medicare coverage as long as you can qualify based on your health But that is a huge, important caveat.

First, it is essential to determine if you have an available time period or circumstance that will allow you to change Medigap coverage without underwriting to see if you can avoid having to qualify based on your health. So, we like to think of this as a flowchart when it comes to deciding your best method for changing Medigap coverage.

So picture the top of the flowchart or the start of the flowchart as being your Medigap open enrollment period. This is a one-time enrollment period that lasts for six months. Starting the first month, you are both 65 or older and enrolled in Medicare Part B for the first time. Now, during this enrollment period, you can enroll in any Medigap plan offered in your state that you are eligible for.

Now, we say that you're eligible because, remember, many of you listening to this are probably not eligible for plan F. So, although you're an open enrollment, you still have to go with the plan letter that you are eligible to purchase. During this time period, you cannot be denied coverage based on your health or pre-existing conditions.

So, if you enrolled in a Medigap plan when you began Part B of Medicare, and you're still within your six-month Medigap open enrollment window, you can still change to a new Medigap plan without restrictions using your Medigap OEP. For example, maybe you started Part B effective 5/1 or May 1st, and you also enrolled in a Medigap Plan G with a 5/1 start date to match your Medicare start date, and you did that using your Medigap Open Enrollment Period.

Now, after doing some research, maybe in August, you decide to change to Medigap Plan N from Medigap Plan G. And if you want to make this change, you can still do so using your Medigap OEP. So, how do you make this change? When changing from one Medigap plan to another during your open enrollment period, it's a pretty easy process.

You just have to submit an application for the new plan, either with your current company or a new company. This does not involve answering health questions. Instead, you will have to fill out basic information like your Medicare number along with your Part A and Part B effective dates.

You will also have to include other things like your full name, your address, payment information, and more stuff like that, but again, you will not have to answer these important health questions like you might outside your open enrollment period. Just make sure when you're changing Medigap plans, really whenever you're changing them, that you cancel your previous Medigap plan once you are fully approved for the new one and before the new one takes effect.

That way, you don't have duplicate coverage that you're paying for. You can do this over the phone by calling the company you have your Medigap plan with, but it is also good to submit something in writing to that company. So, what if you're outside of your open enrollment period? We'll have Joanne talk about that.

Joanne: Let's talk about things like guaranteed issue rights. The next steps of our imaginary changing a Medigap flowchart is seeing if you qualify for guaranteed issue rights. Now, according to the official choosing a Medigap policy guidebook, guarantee-issued rights or Medigap protections are your rights to buy certain Medigap policies in limited situations outside of your Medigap open enrollment period.

Like during your Medigap open enrollment period, insurance companies must sell you a Medigap policy regardless of your health and pre-existing conditions when using guarantee issue rights. Generally, there aren't many guarantee issue scenarios when changing from one Medigap plan to another, but an example would be if your Medigap insurance company went bankrupt and you lost your coverage or your Medigap policy coverage ends through no fault of your own.

We're also going to link to a complete list of guarantee issue scenarios in the show notes. When applying for coverage using guarantee issue rights, you're limited to a specific time frame to enroll, and you'll have to provide proof to Medigap company that you have experienced a situation granting you these guarantee issue rights.

For example, if you lose your Medigap plan, through no fault of your own, your Guarantee Issue Rights last no more than 63 days after your coverage ends. It's also really important to note that unlike during the Medigap Open Enrollment Period if you need to apply for coverage using Guarantee Issue Rights, not all Medigap plan letters will be available to you.

For example, Medigap Plan N is a very popular Medigap plan, but it's not available using Guarantee Issue Rights in most situations. 1 Lastly, just over a dozen states have unique guarantee issue situations like birthday rules, anniversary rules, and more, so we'll put a list of those in the description.

Cameron: Okay, so last but not least, what if you are outside of your Medigap open enrollment period and you do not have the guaranteed issue rights that Joanne just talked about? In this case, you will almost certainly have to go through medical underwriting to change from one Medigap plan to another. This can also apply if the plan letter that you want is not available using Guaranteed Issue.

Like Joanne mentioned, you might want a Plan N, but you only have access to Guaranteed Issue rights, which will not give you that Plan N without health questions. In this case, you can still go through underwriting if you want that Plan N. So remember, this can be done any time of the year, but your acceptance into the new plan is not guaranteed.

Know that Medicare defines underwriting or medical underwriting as the process that an insurance company uses to decide whether to take your application for insurance based on your medical history. Because Medigap plans are offered by many different insurance companies, each company often has its own unique health questions and medical underwriting requirements.

This is why connecting with a broker is so important. We can compare the different requirements for the dozens of different Medigap companies that we contract with to see which ones may accept you into a new Medigap plan based on your specific health history and conditions. The way we typically do this is it starts with a simple phone call with a broker. We ask you some general health screening questions, and we see what companies may be a fit based on the price they are offering and what you can actually qualify for based on your unique health needs. And what we do is ask you the yes or no application questions or health questions on the application for the specific Medigap company.

we think that you may be able to qualify for. We would love to go through every question, but for example, some companies might deny you based on your height and weight limits, while others might not even ask about height or weight. Also, one company may deny you for having COPD. Well, another company might only deny you if you have COPD, plus you also need oxygen or a nebulizer or three or more lung or respiratory-related medications.

That's an actual example from a company. These are just a couple of examples overall, but there are many more like this. So, if after going through the health questions everything seems good to go, we submit the application to the insurance company for them to make the final decision. After submitting the application to the insurance company, generally, there are three options.

You are either approved at that preferred price that we discussed, or you're approved at a higher price, sometimes called a standard price or whatever they may choose to call it, or you are denied. So it is important to know that no matter what, do not cancel your current Medigap plan until you have been fully approved with the new plan and are sure you want to make that switch.

Once you are sure about it, you will want to call your current company that's providing your Medigap policy to cancel, and you want that to coincide with your new plan's effective date, just like we previously talked about. But what if you don't want to change to a new Medigap plan, and what if you want to change to a Medicare Advantage plan from a Medigap plan?

That's exactly what Joanne will talk about. 

Joanne: Unlike changing from one Medigap plan to another, going from a Medigap plan to a Medicare Advantage plan cannot be done at any time of the year. However, you also don't have to qualify for Medicare Advantage coverage based on your health.

So that's the good part. We will break down the process here and your options right now. So, when it comes to changing from Medigap to Medicare Advantage coverage, there are generally two opportunities that you have during the year. These include the fall annual election period or during a special enrollment period.

We'll talk about the annual election period first. So remember, as the name suggests, this enrollment period occurs yearly from October 15th until December 7th. And during this timeframe, if you would like to, you can change from a Medigap and Part D coverage situation to a Medicare Advantage plan. Know that even if you apply for Medicare Advantage coverage from October 15th to December 7th, your new Medicare Advantage plan will not become effective until January 1st of that following year.

So here's an example. If you are enrolled in a Medigap Plan G, and you have a separate drug plan, then on October 15th, you decide you want to change to a Medicare Advantage Plan. What we would do is we would submit an application for the new Medicare Advantage Plan, which would be effective January 1st.

When this enrollment is processed by Medicare, it's going to automatically cancel your Part D prescription plan, effective December 31st. However, if Your Medigap coverage will not cancel on its own, so this is really important. Once your Medicare Advantage application is processed and you're sure that you want to change to that plan, you'll still want to actively cancel your Medigap plan with that current insurance company before January 1st.

This is typically most easily done by calling them and noting when you called and who you spoke to. For extra security, you can also request the cancellation in writing. 

Cameron: Unlike the annual election period that we just discussed, special enrollment periods are another option for changing from a Medigap plan to Medicare Advantage coverage. These generally do not happen during a set time of the year, and instead, they may allow you to enroll in a Medicare Advantage plan when certain events happen in your life.

We will link to a long list of the possible special enrollment periods in the show notes and talk about a couple of options right now. So, an example of this is a possible situation where again, you can change from a Medigap plan along with your Part D coverage to a Medicare Advantage plan during the year outside of those other set enrollment periods.

This can happen if you live in a county where a Medicare Advantage plan with a five-star rating is available. In this case, you can use this special enrollment period once per year between December 8th and November 30th. Your new plan would be effective the first day of the month following your application.

So, if you are enrolled in a Medigap plan in June, for example, And there is a five-star Medicare Advantage plan in your county, you could submit the application for July 1st to make that one-time change. This would cancel your Part D coverage at the end of June, but you would still have to proactively cancel your Medigap plan, as we mentioned if you do want to make that switch fully to Medicare Advantage coverage.

So, here are some overall things to know if you want to change from Medigap coverage to Medicare Advantage coverage. Know that despite what the name sounds like, the Medicare Advantage open enrollment period which occurs from January 1st through March 31st, it does not give you the opportunity to change from Medigap and Part D coverage to Medicare Advantage.

to a Medicare Advantage plan. Lastly, if you are changing from Medigap coverage to a Medicare Advantage plan for the first time, mark your calendars because you will likely have access to a 12-month Medigap trial right period. This period would provide guaranteed issue rights for you to actually go back to the Medigap plan you previously had or a Medigap plan with another insurance company only if your former Medigap plan is no longer available.

 So it's really important. It's a one-time opportunity. If you go to Medicare Advantage from a Medigap plan for the first time and you want to go back to Medigap coverage within those 12 months now, last but not least, what about if you just want to change your part D coverage and you don't even want to touch your Medigap plan?

Joanne: Even more common than changing your Medigap coverage, you're going to likely find yourself in a position where you will want to change your Part D plan without changing that Medigap plan. So luckily, because Medigap coverage and Part D coverage are separate, you can change your Part D coverage to stay updated with your unique prescription medication needs without changing that Medigap plan.

Similar to what we talked about in regards to changing the Medicare Advantage coverage, changing from one Part D plan to another Part D plan will depend on specific enrollment periods, and you do not have to qualify for a new Part D plan based on your current health status. How do you change these?

Well, similarly to what we just discussed with Medicare Advantage plans, changing from one Part D plan to another Part D plan will generally occur during a special enrollment period, or more commonly, During the fall annual election period from October 15th to December 7th. For example, if you apply for a new Part D plan in late October, your new Part D plan that you choose will be effective January 1st of the following year, and your enrollment in the new plan will automatically cancel out The enrollment in the old plan.

So that old plan will stop on December 31st of that year. Some things you should know, though. You should prepare to reevaluate your Part D coverage every single year in the fall, and your plan will send you what we call an annual notice of change in September. So look for those documents. Your Part D coverage will depend on your specific medications and pharmacies, so connect with a broker or run your own analysis using Medicare.gov, which we have YouTube videos showing the very detailed process. It's not that hard to do. And you can find that by going to YouTube and searching for Giardini Medicare. 

Cameron: After you have made your transition to Medicare and enrolled in a Medigap plan, it doesn't mean that you will have that coverage for the remainder of your time on Medicare.

Hopefully, after what we've discussed in this episode, you will be able to confidently understand when and how you can change your Medigap coverage in the future if your unique circumstances allow for it. As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes.

You can always find more Medicare content from us by going to YouTube or TikTok and searching Giardini Medicare. You can also schedule a free phone call with one of our licensed brokers at gmedicareteam.com. Last but not least, send us any questions you have to info@gmedicareteam.com, and have a wonderful day.