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Open Enrollment
The CMS handbook for Medigap, "2008 Guide to Health
Insurance . . ." lays down the Federal "ground rules"
for Medigap. Basically, their
open enrollment rules state that the best time to buy a Medigap policy
is during your open enrollment period, which lasts for six months
beginning the first day of the month in which you are both 65 or over
and enrolled in Medicare Part B. The open enrollment period is the best
time to buy because you are guaranteed the policy at the published
premium. If you buy the policy after the six months, the insurance
company can deny you insurance coverage, place conditions on a policy
or change the price of a policy because of past or present health problems.
However,
the above are Federal penalties and restrictions, and the individual
states do not necessarily have to go along with them. For example, New York State has
continuous, indefinite open enrollment throughout the year, and insurers
may not deny the applicant a Medigap policy for medical reasons. You
simply have to be enrolled in both Part A and Part B of Medicare.
Therefore, in New York State open enrollment also applies to under- 65
Medicare beneficiaries who have qualified for Medicare eligibility on
account of disability or end-stage renal disease. Consequently, these
beneficiaries can purchase Medigap insurance. Further, in New York
State you are protected by "community rating." The premium set for a Medigap policy
by an insurance company is required to be the same without regard to
age, gender or health conditions.
And yet the handbook, "2008 Guide to Health Insurance
. . .” states the possibilities of premiums based on age, gender,
marriage (special rates for couples) and special rates for non-smokers
in some states. So the "story" on Medigap is in two parts.
One part is described in the CMS handbook in terms of the Federal
standards, requirements and consumer protection governing Medigap
policies; the second emanates from your state regulatory agency, which
establishes the "operating" rules. These may include greater
consumer protection and, in general, be more beneficial to the
individual seeking Medigap insurance. So you must check with your State
Insurance Department for the applicable state regulations. The New York State insurance
information line is 1-800-342-3736.
Updated: May 20, 2008
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