What is the Medicare Anniversary rule in Missouri?

Missouri has implemented a set of laws to safeguard the interests of its Medicare beneficiaries through state-specific Medigap regulations, making it one of the few states in the country to do so. These regulations are designed to provide additional coverage and financial protection for Missourians who rely on Medicare to meet their healthcare needs. By enacting these rules, Missouri has demonstrated its commitment to ensuring that its citizens receive the best possible care and support. 

The anniversary rule in Missouri is only implemented on Medigap policies.

What is Missouri Medicare Open Enrollment?

Missouri offers an open enrollment window for Medicare beneficiaries who are new to Medicare, whether they are turning 65 or delayed their Medicare enrollment due to creditable healthcare coverage. This enrollment window lasts for 6 months when enrolling in Medicare Part B, during which beneficiaries can enroll in a Medigap plan without medical underwriting or answering any health questions. Once this window ends, beneficiaries will be subjected to medical underwriting, which means that insurance carriers can deny coverage based on health or prescription history. It is crucial for beneficiaries to enroll in a Medicare Supplement plan during the open enrollment window to avoid being denied coverage due to pre-existing conditions or health history.

If you fail to enroll during this time you may fall under medical underwriting and be denied coverage based on your pre-existing medical conditions. And that is where the anniversary rule kicks in.

Medigap Overview

Medigap, also known as Medicare Supplement Insurance, is a type of health insurance that is designed to fill the gaps in coverage left by Original Medicare. Original Medicare (Part A and Part B) covers many healthcare services, but it doesn’t cover everything. For example, it doesn’t cover certain deductibles, coinsurance, and copayments. Medigap policies are sold by private insurance companies and are designed to help pay for some of the out-of-pocket costs associated with Medicare, such as deductibles and coinsurance. There are several different Medigap plans to choose from, each with its own set of benefits. They are named alphabetically, from the letter A to the letter N, with two high-deductible versions of plans. Some plans cover more than others, and premiums vary depending on the plan and the insurance company. Medigap policies are only available to individuals who have Original Medicare, and they cannot be used to pay for services covered by Medicare Advantage plans. Understanding the benefits and limitations of Medigap can help you make informed decisions about your healthcare coverage and ensure that you have the coverage you need to stay healthy and financially secure.

What If I Want To Change My Medigap Plan?

Enrolling in a Medicare Supplement plan during your OEP window is crucial for several reasons, one of which is the ability to change plans in the future without undergoing medical underwriting. If you do not have a Medigap plan in Missouri and want to enroll in one outside of your medicare open enrollment window, insurance carriers will assess your medical history and can deny you coverage. However, if you have a Medigap plan, the Missouri Anniversary Rule allows you to change plans once a year without undergoing medical underwriting. This means that insurance carriers must accept you into their plan, regardless of your health history, as long as you qualify for the Missouri Anniversary Rule.

How Missouri Anniversary Rule Works?

Medicare beneficiaries in Missouri who have enrolled in a Medigap plan can take advantage of the Missouri Anniversary Rule, a state-specific rule that enables them to change their plan without medical underwriting. This rule is especially significant because it allows beneficiaries to shop for plans and lower their premiums even if they have pre-existing conditions or a significant health event. Missouri is one out of 7 states with extra Medigap guaranteed issue rules.

To be eligible for the Missouri Anniversary Rule, beneficiaries must meet specific criteria.

To be eligible for the Missouri Anniversary Rule, Medicare beneficiaries must currently have a Medigap plan. Those who are enrolled in a Medicare Advantage plan or have no supplemental coverage will not qualify. Beneficiaries who have Medigap plan A-N will be eligible for the rule, although their plan will affect the extent to which they switch their plans to different insurers.

Medicare beneficiaries in Missouri can use this rule to switch their plan every year within a 60-day window, starting 30 days before their policy anniversary date and ending 30 days after it. This window occurs annually at the same time, which makes it easy to remember.

The Missouri Anniversary Rule permits beneficiaries to switch their Medigap plan to one with equal coverage without requiring medical underwriting. Essentially, beneficiaries can change to a plan with the same benefits, but they cannot switch to a plan with lower benefits or a plan with higher benefits without undergoing medical underwriting. In order to increase their benefits, beneficiaries would need to go through the medical underwriting process.

For example, beneficiaries could make changes to the same plan with different carriers (from plan G to Plan G).  They can’t switch from plan G to plan F since this is the most comprehensive plan available. Furthermore, they cannot switch to a plan with lesser benefits without medical underwriting, like switching from plan F to N.

Also, note that beneficiaries who weren’t able to Medicare prior to January 1st, 2020 can no longer purchase plans F and C. 

Are Anniversary Rule and Birthday Rule the Same Thing?

No, they are not the same thing.  The Medicare Supplement birthday rule is an annual protection for Medicare beneficiaries in six states. This open enrollment period allows for the purchase of a Medigap plan without underwriting or waiting periods around the time of one’s birthday. Each state has its own unique parameters for this opportunity, including varying time frames and carrier restrictions. Additionally, age parameters may affect when the rule applies to one’s benefits. The birthday rule is not available in the state of Missouri.

On the other hand, with the Anniversary rule is possible to switch from one insurance company to another for your Medigap plan 30 days before or after your policy’s yearly anniversary date.

Medigap plans Birthday Rules

One important thing to know about Medigap is the Birthday Rule. The Birthday Rule allows you to switch from one Medigap plan to another within 30 days of your birthday each year, without being subject to medical underwriting. This means that you can switch to a different plan that better fits your needs, without worrying about being denied coverage or charged higher premiums due to any pre-existing conditions you may have. It’s important to note that the Birthday Rule only applies if you already have a Medigap plan and want to switch to a different one. If you’re new to Medicare and want to enroll in a Medigap plan, you may not be eligible for the Birthday Rule. Understanding the Birthday Rule and other Medigap rules can help you make informed decisions about your healthcare coverage and ensure that you have the coverage you need to stay healthy and financially secure. There are six states that have implemented the Medicare birthday rules, and they are following: California, Idaho, Illinois, Louisiana, Nevada, and Oregon

What Are My Guaranteed Issue Rights With Medigap Policies?

When you experience a major change in your health coverage and become eligible for Medicare, the Guaranteed Issue Rights mandate that insurance companies must offer you Medigap coverage. This policy requires that insurers provide coverage for all preexisting health conditions and prohibits them from charging you more based on past or current health conditions. These protections are available outside the Medigap open enrollment period, which is a six-month window that begins once you are 65 or older and enrolled in Medicare Part B.

So, guaranteed issue rights are situations in which you have the right to purchase a Medigap plan without being denied or charged more due to your health status. There are several situations in which you have guaranteed issue rights, including if your Medicare Advantage plan ends or if your group health plan ends. You can also buy a Medigap policy if you are moving out of a Medicare SELECT coverage area or if your Medigap insurer goes out of business. In case the insurer violates rules or regulations, you can drop a Medigap or Medicare Advantage plan and buy a certain Medigap plan from any insurance company in your state within 63 days after the date your coverage ends. Additionally, you have trial rights to test-drive a Medicare Advantage plan and still buy a Medigap policy if you change your mind. Suppose you switch from Medigap coverage to a Medicare Advantage plan and want to change back. In that case, you can purchase your previous policy if it’s still available or a Medigap policy from any insurer in your state within 63 days of when your Medicare Advantage coverage ends.

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