Many Medicare beneficiaries who already are covered by a Medicare Supplement (aka Medigap) plan, such as Plan F or N, often incorrectly think they can make changes to their health plan only once a year―during the Annual Election Period (AEP), which falls between October 15th and December 7th.

Not true. If you currently have a Medigap plan, you can apply for another plan with the same insurer or with a different one at any time of the year. But, you should know the guidelines:

  • When you decide to apply for a new Medigap plan, you’ll likely undergo medical underwriting―you’ll need to answer questions about your current health and medical history.
  • Depending on the insurer’s underwriting criteria, your request for new coverage might be denied because of your medical history or specific conditions.
  • Some insurers do accept applicants who have one or more medical conditions. In this case, the insurer can charge the applicant an adjusted (higher) premium.

If you want to convert your Medigap plan to a Medicare Advantage plan―an HMO or PPO with Part D prescription drug coverageyou can make this change only during AEP (Oct. 15 – Dec. 7). Your new Medicare Advantage plan will then be effective on January 1 of the following year.

When you change from a Medigap plan to a Medicare Advantage plan, you must cancel your Medigap plan, effective the date your new plan becomes effective. Otherwise, you’ll have duplicate coverage and your claims will not be processed.

Other Rights: Guaranteed Issue and Trial Right.

Beneficiaries whose Medigap plan is withdrawn from the service area by the insurer are allowed to purchase a new Medigap plan without the need to undergo medical underwriting.

Medicare also gives beneficiaries who voluntarily leave a Medigap plan to enroll in a Medicare Advantage plan for the first time a Trial Right―that is, if at any time during the first year on the Medicare Advantage plan beneficiaries want to return to your Medigap plan, they can.

Specific rules apply, however, for both Guaranteed Issue and Trial Right purchases. Before making changes, beneficiaries should call their Broker of Record or visit www.medicare.gov.

Many people new to Medicare are unaware that Medicare covers a one-time a “Welcome to Medicare” preventive visit and follow-on annual wellness visits. These services are offered at no cost to Medicare Beneficiaries as long as your provider accepts Medicare assignment. But there are guidelines for obtaining these services at no cost:

  • A one-time “Welcome to Medicare” visit is available only within the first 12 months of being covered under Medicare Part B. During this visit, your physician reviews your overall health and potential risk factors; takes measurements, such as those for height, weight, and blood pressure; performs a simple vision test; provide information about preventive screenings; and identify other care and services that might be beneficial.
  • The “Annual Wellness Visit” is available each year after you’ve had Medicare Part B for more than 12 months. Your physician develops personal prevention plan; reviews your medical and family history, your key providers, and your medications; takes various measurements; tests for cognitive impairment; and lists risk factors and treatment options. If you schedule an annual visit before a full year has elapsed, Medicare will not cover it and you will be charged.

You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts Medicare assignment (e.g., contracts with Medicare and agrees to Medicare’s reimbursement schedule). For these visits, the Part B deductible doesn’t apply. However, you may have to pay coinsurance, and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under preventive benefits.

For more details, visit the Medicare website at: https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html.