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Section 2: Other Medicare Health Plans (continued)   |
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Q: What happens to my Medigap policy if I join a Medicare managed care plan, drop my Medigap policy, and then later disenroll from the health plan? A: You may be able to return to a Medigap policy that you dropped to enroll in a Medicare SELECT policy or a Medicare health plan other than the Original Medicare Plan (for example, a Medicare managed care plan). However (1) this must be the first time that you joined a Medicare managed care plan or Medicare SELECT policy; (2) you must leave the Medicare managed care plan or Medicare SELECT policy within one year after joining; and (3) after leaving your Medicare managed care plan or Medicare SELECT policy, you must apply for your former Medigap policy within 63 calendar days after the health plan coverage ends if your previous Medigap insurance company still sells the policy in your State. If your previous Medigap policy is not available, you are guaranteed the right to purchase Medigap policies “A”, “B”, “C”, or “F” from any insurance company which sells these plans in your State if you apply within 63 calendar days after coverage ends. In these cases, the insurance company may not: • Deny you insurance coverage or change the price of a policy because of past or current health problems, or • Delay the start of your Medigap Policy coverage if you have a pre- existing condition. The protections and guarantees described above may apply when you lose or drop coverage under a Medicare SELECT policy. All rights to buy a Medigap policy under these protections and guarantees include the right to buy a Medicare SELECT policy since it is a type of Medigap policy. If you currently have a Medicare SELECT policy, you also have additional rights for as long as you have this policy that might provide you with better options for changing your insurance coverage. After you have had the Medicare SELECT policy for at least 6 months, you can switch to a regular Medigap policy sold by the same company, as long as the new policy has equal, or less coverage than the Medicare SELECT policy. Q: If I lose my health plan coverage will I be able to get a Medigap policy? A: If you lose health coverage under certain circumstances, you will have a guaranteed right to purchase Medigap policies “A”, “B”, “C”, or “F” that are sold in your State, as long as you apply within 63 calendar days of losing your other health coverage. The circumstances include the following: • Your Medicare managed care plan terminates its participation in Medicare or stops providing care in your area. • You move outside the plan’s service area. • You leave the plan because it failed to meet its contract obligations to you. • You were in an employer group health plan that supplemented or was secondary payer to Medicare and the plan terminates coverage. • Your supplemental insurance company terminates your Medigap policy or Medicare SELECT policy (and you’re not at fault). You will be given credit for any previous health coverage you had to meet the pre- existing condition requirement. Q: Does this protection cover me if I am under age 65 and am eligible for Medicare because I am disabled or have End- Stage Renal Disease? A: If you live in a State where Medigap policies are sold to people under age 65 who are eligible for Medicare due to disability or ESRD, you may have the same protection as those over age 65 if your health insurance ends or is lost. If Medigap insurance companies in your State sell Medigap policies “A”, “B”, “C”, or “F” to people under age 65, they must also make these policies available to you when your health coverage ends or is lost. Call your State Health Insurance Assistance Program* for more information. * You can find phone numbers for your area in your copy of Medicare & You or on the Internet at www.medicare.gov under Important Contacts. |
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