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Medicare beneficiaries sometimes have rare opportunities to purchase a Medigap Policy outside of their initial enrollment period with Guaranteed Issue Rights: Medicare.gov - Medigap Enrollment. One instance is when a Medicare Advantage (MA) plan they are enrolled in is no longer available in their area. This is a situation that beneficiaries in Clackamas County are experiencing if they are currently enrolled in a Providence or PacificSource MA plan. Here are some rules to keep in mind:
- These discontinued MA plans continue through the end of this calendar year, so if you decide to purchase a Medigap policy, the start date should be January 1. You cannot have or use both a Medigap policy and a MA plan at the same time, so be sure they don’t overlap.
- If you switch to a Medigap policy, you will need to enroll in a standalone Part D plan to avoid a lapse in prescription coverage. For most beneficiaries, you need to do this during the annual Medicare Open Enrollment Period, October 15 through December 7, but if your plan is ending, you have additional time.
- Once you have a Medigap policy, if you want to change to a different company or different plan and ensure Guaranteed Issue here in Oregon, that can be done up to 30 days before your birthday and up to 30 days after (called the Birthday Rule). You will only use the Medicare Open Enrollment Period if you need to change your Part D plan.
- Do not provide your Medicare number, Social Security number, or bank information to anyone before you decide to enroll in a plan.
Volunteer SHIBA counselors provide free, objective Medicare facts to help beneficiaries make informed decisions for themselves. No products or services are sold by SHIBA.
The Senior Medicare Patrol (SMP) is a partner program of SHIBA that educates Medicare beneficiaries on how to detect, prevent, and report Medicare waste, fraud, and abuse. If you have any concerns about Medicare fraud, please call us at 503-655-8269.
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