Switching Medigap plans in New York

The New York rule in one paragraph

Federal law only guarantees you a Medigap policy during your six-month Medigap Open Enrollment Period, which starts the month you're 65 and enrolled in Part B, and in a handful of "guaranteed issue" situations afterwards. Outside those, insurers in most states can review your health, charge more, or decline you. New York goes further: state law requires every Medigap insurer to accept any Medicare beneficiary, at any time, without medical underwriting, and to charge everyone on a plan the same community rate. In practice, that means you can treat a Medigap plan the way you'd treat a car insurance policy: shop it, and move if there's a better deal.

The three kinds of switch

• Same plan letter, different carrier. Plan G is Plan G by law, whoever sells it. The only things that differ are the premium, the carrier's history of rate increases, and small extras such as household discounts. This is the most common switch, and the one people should do more often.
• Different plan letter. Moving from Plan G to Plan N to save on premium, or from N to G because you're now at the doctor every week. The Plan G vs Plan N guide covers that decision.
• From Medicare Advantage to a Supplement. The Medigap side is easy in New York. The hard part is timing your exit from the Advantage plan and lining up a Part D plan, covered below.

The waiting period, explained properly

This is the part that gets garbled online. A New York Medigap insurer may impose a waiting period of up to six months before it covers a pre-existing condition, meaning something you were treated or advised about in the six months before the policy started. Original Medicare still pays its share during that time; only the Medigap portion of the bill for that condition is affected.

The insurer must reduce that waiting period by every month of creditable coverage you had before, as long as there was no gap of 63 days or more. A previous Medigap policy, a Medicare Advantage plan, employer or union coverage all count. Someone who has been continuously covered for six months or more therefore switches with no waiting period at all. The only people who actually face one are those who went without coverage for two months or more, or who are new to Medicare and didn't have prior coverage.

When switching is worth it

• Your carrier has raised rates faster than the market. Community rating means everyone on your plan got the same increase, but carriers differ a lot in how their premiums have moved over five years. A carrier that's cheap today and has a history of steep increases is not a bargain.
• You're on Plan F. If you were eligible for Medicare before 2020 you can keep Plan F, but it has been closed to new enrollees since then, which tends to push its premiums up over time. Plan G covers everything F does except the Part B deductible, often for less than the deductible is worth.
• Your usage has changed. Fewer doctor visits point toward Plan N or high-deductible G; a new chronic condition points toward G.
• A household discount is available. Some carriers discount when two people in a household hold policies with them. If you and your spouse are with different carriers, consolidating can save real money.

When it isn't

• A small premium difference. Switching for a few dollars a month, to a carrier whose rate history you don't know, is rarely worth the paperwork.
• Mid-treatment with a gap in coverage. If you've had a break of 63 days or more, a waiting period could apply to the condition you're being treated for. Wait until treatment is done, or accept the wait knowingly.
• Chasing extras. Gym memberships and discount programs are pleasant but they aren't insurance. Compare the premium and the rate history; treat the rest as a tie-breaker.

Switching from Medicare Advantage to a Supplement

The Medigap policy itself is available any time. Leaving the Advantage plan is not: you can drop it during the Annual Enrollment Period (October 15 to December 7, for January 1), during the Medicare Advantage Open Enrollment Period (January 1 to March 31, if you're already enrolled in an Advantage plan), or with a Special Enrollment Period such as moving or the plan being discontinued. Because most Advantage plans include drug coverage, leaving one also means enrolling in a standalone Part D plan in the same window, or you'll go without drug coverage and start collecting a late-enrollment penalty after 63 days.

The right sequence is: line up the Medigap policy and the Part D plan for the same effective date, then let the Advantage plan end. If your Advantage plan is being discontinued, see what to do when your Medicare Advantage plan is discontinued.

Under 65 and on Medicare

New York also requires insurers to sell Medigap to people on Medicare because of disability, at the same community rate. Many states don't. If you're under 65 on Medicare in New York, the same switching rules above apply to you.

How I handle a switch

1. Compare your current premium against every carrier I'm appointed with for the same plan letter, plus the alternatives (G, N, high-deductible G), with each carrier's rate history.
2. Confirm your continuous coverage so the waiting period is zero, and check whether a household discount applies.
3. Submit the new application with a first-of-the-month effective date, then cancel the old policy once the new one is confirmed.

There's no fee for any of this; the carrier pays a commission, and your premium is the same whether you apply through me or directly. Ask for a Medigap comparison, or read about Medigap in New York more generally.

I do not offer every plan available in your area. Any information I provide is limited to the plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program for information on all of your options. Not connected with or endorsed by the U.S. government, the Social Security Administration or the federal Medicare program.