Can someone buy a medigap insurance policy if she joined a managed care plan?

If a person joined a Medicare Part C "Medicare Advantage" managed care plan when first eligible for Medicare at age 65 but leaves that plan within a year, she can buy any medigap policy offered in her state, without any medical screening, limits on coverage, or higher premiums. In other words, she returns to the same position she would have been in had she bought a policy within the first six months of turning 65.

Is a person eligible for a medigap insurance policy if she's been dropped by a managed care plan?

With unfortunate frequency over the past few years, some Medicare Part C Medicare Advantage managed care plans have decided to quit doing business in certain geographic areas. When they do, they're allowed to simply drop all the people who were enrolled in the plan. If that happens, the person has within 63 days of the end of her managed care plan to enroll in any medigap Plan A, B, C, or F policy sold in her state.

She's guaranteed enrollment in any one of these policies she chooses, without any medical screening and regardless of her medical history. She's eligible for the same terms and conditions as anyone else buying the policy for the first time. And her monthly premium will be the same as that of anyone else of her age who already has the policy.

If the person had a medigap policy and dropped it to join a managed care plan that has now dropped her, she has the right to buy that same medigap policy again, regardless of the plan type.

Can someone buy a medigap insurance policy now if she didn't buy one or join managed care at age 65?

If she didn't buy a medigap policy within the first six months of enrolling in Medicare Part B and wasn't enrolled in a Medicare managed care plan that dropped her, she can still buy a medigap policy. But now the insurance companies have all the leverage -- Medicare regulations do very little to help her. An individual insurance company can decide whether it wants to sell someone a particular policy (though it has to be one of the 12 standard plans) and under what terms.

For example, the insurance company can require a person to undergo medical screening. Based on her age or health history, the company might offer to sell her some policies but not others. It might also place limits on coverage, such as six months of exclusion before coverage begins for certain conditions. The company can also charge her a higher premium than for other people with the same policy, and it may include policy provisions that increase premiums faster or more abruptly than for other policy holders.