MEDIGAP SIX-MONTH OPEN ENROLLMENT PERIOD

When Open Enrollment Starts

Clarification of Rights for Disabled and End State Renal Disease (ESRD) Medicare Beneficiaries When They Turn 65


In December, 2002, the Centers for Medicare and Medicaid Services (CMS) issued a bulletin addressing two issues: 1) timing of the 6 month open enrollment period for Medigap; and 2) open enrollment rights of disabled persons and those with End Stage Renal Disease (ESRD) when they turn 65.

1. Timing of the Open Enrollment Period

The CMS bulletin clarifies that the 6 month Medigap open enrollment period begins for an individual on the first day of the first month after he/she has both a) attained age 65 and b) become entitled to Medicare Part B benefits.

  1. An individual attains age 65 on the first day of the month in which the individual ’s 65th birthday falls. For example, an individual whose 65th birthday is October 15, 2003 will be deemed to have attained age 65 on October 1, 2003. Exception: For an individual whose birthday falls on the first day of the month, he/she is deemed to have attained age 65 on the first day of the previous month. For example, an individual whose 65th birthday is October 1, 2003 will be deemed to have attained age 65 on September 1, 2003.

  2. An individual becomes entitled to Medicare Part B benefits when he/she has been accepted into the Medicare program. An individual’s Medicare card will indicate the date on which he/she became entitled to Part B benefits. (The date on which an individual applies for Medicare is generally not the same as the date on which he/she becomes entitled to benefits.)

2. Open Enrollment Rights of Disabled and End Stage Renal Disease (ESRD) Medicare Beneficiaries When
    They Turn 65

  1. Earliest Possible Effective Date of Medigap Coverage

    A disabled or ESRD beneficiary who was entitled to Medicare Parts A and B before turning 65 is reclassified as an aged beneficiary when he/she attains age 65 (as defined above). His/her Medigap 6-month Open Enrollment period begins at this time. Medigap insurers are not allowed to use definitions of attain age 65 other than the definition in 1(a) above.

    The Medicare statute allows beneficiaries to apply for Medigap policies "prior to" as well as during the open enrollment period. If a disabled or ESRD beneficiary applies early enough, he/she can ask to have his/her Medigap policy start on the first day he/she is entitled to Medicare Part B as an aged beneficiary.

  2. Beneficiary’s Right to Apply for a New Medigap Policy after Attaining Age 65

    Disabled beneficiaries who are covered by Medicare before age 65 can use the Open Enrollment period after attaining age 65 to apply for a new Medigap policy with the same or a different insurer. The benefits of reapplying after attaining age 65 may include: 1) getting better rates for the same policy from the beneficiary’s current insurer; 2) switching to an insurer not available to the beneficiary when he/she was under age 65; and 3) upgrading benefits while getting the "best rate" offered to all individuals over 65.

    It is the beneficiary’s responsibility to reapply
    . Insurers are not required to notify a beneficiary of his/her right to reapply. Nor are insurers required to re-rate their policies automatically when a beneficiary attains age 65.

A copy of this CMS bulletin can be obtained at www.cms.gov/medigap/mdgp0203.pdf.


© Center for Medicare Advocacy, Inc. 08/19/13