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Situation #1 : Your Medicare + Choice plan or PACE program coverage ends because the plan is leaving the Medicare program or stops giving care in your area. In this situation, your Medicare + Choice plan or PACE program sends you a letter telling you that you will no longer be covered by the plan. This may be because the plan is leaving the Medicare program or stops giving care in your area. If this happens, the right is had by you to buy Medigap plan A, B, C, or F that is sold in your state by any insurance company.

You can buy the policy at the best premium price available, with no review of your medical records if you have health problems even. You can apply for a Medigap policy as as you get the final notification letter from your plan soon. When you get this letter telling you that your plan is leaving the Medicare program or will no longer give care in your area, you may have three choices:

1 . Switch to another Medicare + Choice plan in your area. The final notification letter shall tell you if there are other plans available in your area. In some cases, you may have to wait until the new plan you want to join is accepting new members. If you join a new Medicare + Choice plan when your current plan coverage ends, you will not need (or be able to use) a Medigap policy.

2. Leave your Medicare + Choice plan or PACE program (disenroll) any time between the date you get your final notification letter and when your health coverage ends. Unless another Medicare is joined by you + Choice plan, you will automatically return to the Original Medicare Plan when you leave (disenroll from) your plan or PACE program. You have 63 calendar days from the day you leave your plan or PACE program to apply for a Medigap policy.

3. Stay in your plan or PACE program until the date your coverage ends. Unless you join another Medicare + Choice plan, you will return to the Original Medicare Plan when your coverage ends automatically. You have 63 calendar days after your health coverage ends to apply for a Medigap policy. 43 Section

3: More Detailed Medigap Policy Information Medigap Protections



Situation #1: Your Medicare + Choice plan or PACE program coverage ends because the plan is leaving the Medicare program or stops giving care in your area, (continued) Important: You will have additional rights under Situation #4 or Situation #5 if this was the first time you were in a Medicare + Choice plan, you were in the plan less than one year before the plan left the Medicare program or stopped giving care in your area, and you choose to return to the Original Medicare Plan and apply for a Medigap policy. If instead, you immediately join another Medicare + Choice plan, you can stay in that plan for up to one year and still have the rights described in Situations #4 and #5.

Situation #2: Your employer group health plan coverage ends. You are in an employer group health plan that pays some or all of the costs not paid by Medicare, but plan coverage ends because the employer goes out of business or cancels your company coverage. You have the right to buy Medigap plan A, B, C, or F that is sold in your state by any insurance company. You can buy the policy at the best premium price available, with no review of your medical records even if you have health problems. You may get a letter or a notice from your employer, the ongoing health plan, or insurance company telling you your coverage has been or will be cancelled.

You have 63 calendar days from the date your coverage ends or from the date on the letter or notice (whichever is later) to apply for a Medigap policy. In some cases, you will not get a notice, but you might get a claim denial because your coverage has ended. If this happens, this claim denial is the same as a letter telling you that your coverage has ended. Remember, keep a copy of the letter, notice, claim denial, and postmarked envelope. You may need these papers to prove you lost coverage. You shall need to send a copy of the letter, notice, or claim denial with your application in order to buy a Medigap policy.