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Vol. 15, Issue 24 – November 28, 2016
When can I buy a Medigap? Dear Marci,When I turn 65 in a few months, I’ll enroll in Original Medicare, but I’m not sure if I want to purchase a Medicare supplement insurance plan at that time. Is that possible, and what are my options for purchasing a supplemental policy?

– Skip (Surprise, AZ)

Dear Skip,

Under federal law you only have the right to buy a Medicare supplement insurance plan or Medigap if you are 65 or older and you buy your policy during certain times. These times include during your Medigap Open Enrollment Period and when you have a guaranteed issue right. When you enroll during one of these times, Medigap insurers cannot deny you coverage and must offer you a Medigap at the best available rate.

If you have Original Medicare, Skip, you have the right to buy a Medigap for up to six months, beginning with the month you are 65 or older and enrolled in Medicare Part B. This six-month period, in which you are both 65 and enrolled in Part B, is known as the Medigap Open Enrollment Period. Under federal law, you do not qualify for this Open Enrollment Period if you are under 65. However, once you turn 65, you qualify for this Open Enrollment Period during the six-month period beginning with the month you are both 65 or older and enrolled in Part B.

If you want to purchase a Medigap during your Medigap Open Enrollment Period, insurance companies cannot turn you down based on pre-existing conditions. However, if you have a medical condition or illness prior to purchasing the Medigap, Medigap insurers can impose a pre-existing condition waiting period, meaning that the plan will not cover any health services related to the pre-existing condition for a period of up to six months. If you had certain other kinds of coverage before you buy your Medigap, your waiting period may be shortened.

A guaranteed issue right means that you have the right to buy a Medigap outside of your Open Enrollment Period, and insurance companies cannot deny you coverage. If you are 65 or older, you have a guaranteed issue right to purchase a Medigap within 63 days of losing or ending certain kinds of health coverage and in some other circumstances. When you have a guaranteed issue right, companies must sell you a policy at the best available rate, regardless or your health status, and cannot deny you coverage. For example, you will have a guaranteed issue right if your current employer or retiree coverage that pays after Medicare ends.

There are some states that have more flexible enrollment rules than the federal government and require Medigap insurers to sell you a policy at other times. Some states extend open enrollment and guaranteed issue protections to people under 65 and some have continuous open enrollment, meaning you can buy a policy at any time. On the other hand, you may run into problems if you try to buy a Medigap policy outside of Open Enrollment or Guaranteed Issue periods in other states. Companies can refuse to sell you a policy or may only let you buy one if you meet certain medical requirements. If an insurance company does agree to sell you a policy, you may pay a higher premium as a result of your health status. You can learn more about Medigap enrollment in your state by contacting your State Health Insurance Assistance Program (SHIP).

– Marci

Health Tip
Many adult children of aging adults know how difficult it can be to talk with their parents about certain topics. The following tips from Home Instead Senior Care® can help family caregivers have healthy communication with their aging parents on sensitive subjects.

Get Started. If you’re 40 or your parents are 70, it’s time to start observing and gathering information carefully and thoughtfully. Don’t reach a conclusion from a single observation.

Talk it out. Approach your parents with a conversation. Discuss what you’ve observed and ask your parents what they think is going on.

Sooner is best. Talk sooner rather than later when a crisis has occurred.

Forget the Baby Talk. Remember you are talking to an adult, not a child. Put yourself in your parents’ shoes and think of how you would want to be addressed in the situation.

Maximize the Independence. Always try to move toward solutions that provide the maximum amount of independence for the older person. Look for answers that optimize strengths and compensate for problems.

Be aware of the whole situation. If dad dies and soon afterward mom’s house seems to be in disarray, don’t assume she suddenly became ill. It’s much more likely to stem from a lack of social support and the loss of a life-long relationship. Make sure that mom has friends and a social life.

Ask for Help. Many of the issues of aging can be solved by providing parents with the support they need to continue to maintain their independence.

To learn more communication tips and to download a free copy of an action plan for successful aging, visit 4070talk.com.

Need to Know
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After the recent election, the implications for people with Medicare and their families remain unclear, so we need your support now more than ever to protect and strengthen Medicare for older adults and people with disabilities. Help us ensure that lives are not at risk because people cannot access health care with their Medicare coverage. 

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Dear Marci is a biweekly e-newsletter designed to keep you — people with Medicare, social workers, health care providers and other professionals — in the loop about health care benefits, rights and options for older Americans and people with disabilities.

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