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Your rights when buying Medicare insurance

You might feel confused by all the different health insurance options and choices you have to make when you turn 65. No matter whether you choose Original Medicare or a Medicare Advantage Plan, you are guaranteed certain rights. Among them:

You are guaranteed to be treated with dignity and respect. Some unscrupulous agents may think just because you're older, you're easy prey, but you should never let anyone intimidate you when you are researching and signing up for your Medicare benefits and Medicare supplement insurance (also known as Medigap), says Cheryl Matheis, senior vice president of AARP. If someone treats you wrongly, report him or her to your state insurance department.

medicare insurance rightsYour questions about your Medicare coverage must be answered. You may be able to find the answers to common questions at the Medicare website. You also can call the Medicare help line at 1-800-633-4227, 24 hours a day, including weekends. Your state insurance department also may be able to answer your general questions about health insurance plans.

Your questions must be answered in a way that you understand, whether the answers come from Medicare, the people at your health insurance plans or, under certain circumstances, contractors.

You must be accepted in a Medicare supplemental plan if you apply when you enroll in Medicare. You can't be turned down for health reasons, says Lucas Burton of Golden Age Providers in Largo, Fla. If you want to switch Medigap insurance plans, you might be refused, but not when you first enroll, he says.

Your Medigap insurance policies must be renewed as long as you pay your premiums. You can't be dropped for making claims, Matheis says. Don't let anyone tell you that if you make too many claims on your Medigap health plan, you may lose it.

You can make changes to your health and prescription drug coverage. In most cases, you can make these changes during the open enrollment period, which for 2018 is earlier than usual, Oct. 15 to Dec. 7. Any changes made during that time take effect on Jan. 1, 2019. 

There are special circumstances that allow you to change your Medicare health or prescription drug coverage at other times of the year, Burton says. The circumstances may depend on the state in which you live.

For example, Burton says, California allows you to buy Medicare supplement insurance -- and the coverage can be the same as you have or less -- during the month of your birthday, and the Medigap insurance plans can't ask you questions about your health. Another example is Missouri, which has its own annual enrollment period. "If you live in Missouri, every year on the annual anniversary of your existing policy, you can buy the same Medicare Supplement plan that you have without evidence of insurability," Burton says.

You can appeal decisions about coverage for services or prescriptions drugs. You can file an appeal if your plan denies coverage or stops paying for items or services you believe you need. If you have Original Medicare you must fill out a Medicare Summary Notice within 120 days of obtaining it. You should receive a decision within 60 days. If you have a Medicare Advantage Plan, you must file the instructions from your plan. If you need help with your appeal, you can contact your State Health Insurance Assistance Program.

Tips for buying Medicare policies

If you are buying Medicare coverage, you should also keep these tips in mind:

Take advantage of the comparisons on Medicare.gov. "They've gone to great lengths to put the information there and organize it so that people understand what's important and what they need to consider," Matheis says.

Remember that your first decision is going to be your most important. Your first enrollment decision is critical, Matheis says, because after it becomes more difficult to make changes in your medical insurance coverage and prices will increase if you're applying as you get older.

"I recommend that people don't focus on their current medical conditions," Matheis says. "Buy for what might happen and not what's happening with your health." For example, she says, some people decide not to buy a drug plan because they're not taking any medications. However, as you get older, it's more likely you will be given medications. "If you don't buy a drug plan when you first enroll, you'll pay penalties should you want or need one later," she says.

Pay attention to deadlines. You can make changes to your plans during the open enrollment period. You may be granted a special exception and be able to make changes if you have a particular problem at other times of the year, but it's not always easy to be granted an exception. It's much easier if you apply during the standard enrollment periods, Burton says.

Reasons for having a special enrollment period includes a spouse's death, losing a job and moving. 

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