Medicare

Buying a Policy During Open Enrollment

Buying a Policy During Open Enrollment

The best time to apply for Medicare Supplement plans is during the Open Enrollment Period. This period is 6 months and begins the first day of the month in which you’re 65 years or older AND enrolled in Medicare Part B. Let’s say you turned 65 on July 31st but you didn’t enroll with Medicare Part B until September 28th. This would make your Open Enrollment period start on October 1st, the first day of the month you’re both 65 years old and enrolled in Medicare Part B.

 Why you Should Buy a Policy During Open Enrollment

During open enrollment, carriers are required to sell policies at the best premium rates regardless of health status. They can’t deny coverage. Your best available premium rate is calculated on multiple factors, including age, residence area, gender, and smoker-non-smoker status. If you apply for Medicare Supplement plans in open enrollment, insurers have limited ability to exclude coverage for a pre-existing condition or other conditions you had prior to enrollment.

What Happens if I Miss the Enrollment Period?

There is no guarantee issue right and your application may not be accepted if you apply after your open enrollment period. Carriers are allowed to use medical underwriting to aid in their decision on whether or not to accept your application and how much to charge.

 If you don’t apply during your Open Enrollment Period a carrier can:

  • Delay the start of your coverage
  • Refuse to sell you any policy they have
  • Charge you a higher premium

Again, insurers must sell policies at the best available premium rate if you have a guaranteed issue right. Insurers can’t deny coverage to you regardless of your residential area, age, gender, or smoker or non-smoker status. Insurers can’t require a waiting period to cover you for pre-existing conditions. Check with your State Health Insurance Assistance Program to check whether you’re receiving the best available rate for your policy.

Keep copies of letters, claim denials, notices, and postmarked envelopes to prove your right to guaranteed issue because you ceased or lost health care coverage. Insurers might ask for these documents before allowing you to purchase a policy.

 Pre-Existing Condition Waiting Period

In some cases a carrier may be able to make you wait for coverage related to a pre-existing condition, but as long as you enrolled during your Open Enrollment Period they cannot delay the start of your overall coverage.

The carrier can only delay your coverage if the condition was either treated or diagnosed within the six month period before your policy starts. Original Medicare will still cover the condition, but you’ll still be responsible for any coinsurance or co-payments.

Buying a Policy During Open Enrollment

Do I Need a Supplement Policy

The answer is you might not need a Medicare Supplement insurance plan if you’re healthy and don’t need to visit the doctor often. The decision to buy a Medigap policy depends on your personal circumstances.

If you receive outpatient testing and treatments, Medicare Part B covers up to 80 percent of approved charges, including doctor office visits, emergency room visits, blood tests, CT scans, MRIs, CT scans, etc. If you receive IV medications or infusions at the doctor’s office, hospital, or nursing home, you pay a Part B deductible based on the year in which the costs are submitted to Medicare.

It’s important to realize what “Medicare pays up to 80 percent of approved charges” means. For instance, if the doctor orders an MRI of your brain, the hospital might charge Medicare $10,000.

Medicare’s reviewers might say, “The MRI shouldn’t have cost more than $7,000 in your local market.”

That means Medicare will pay some of the bill and you pay the amount according to Medicare plan deductibles for that year. You won’t pay the full amount that Medicare doesn’t pay—the remainder of the hospital bill is disregarded.