Washington Medigap rules, explained

The short version

• Same price at any age. Each insurer charges all its 65+ policyholders the same premium for a plan.
• Switch any time. If you have Medigap Plan B through N, you can move to another Plan B through N whenever you like, with no health questions.
• Short waiting periods. Pre-existing condition exclusions can't last longer than three months, and don't apply at all when you replace coverage you've had for three months.
• Under 65 isn't protected. Insurers don't have to sell Medigap to people on Medicare because of a disability, and few do.

Community rating: no age pricing

In most states, insurers price Medigap by age. Some charge more each birthday ("attained age"); others lock in a price based on your age when you buy ("issue age"). Washington allows neither. Under RCW 48.66.045, an insurer must charge the same premium to everyone who holds the same standardized plan. Insurers may keep at most two rating pools, one for people eligible by age and one for people eligible by disability or end-stage renal disease.

The only allowed differences are discounts for spouses and for how and how often you pay. That's why the state chart can show one premium per insurer per plan, and why the price you're quoted at 65 is the price an 85-year-old pays for the same plan.

What community rating doesn't do is freeze premiums. Insurers file rate changes with the Office of the Insurance Commissioner, and an approved increase applies to everyone in the pool.

Switching plans any time

Washington has no yearly Medigap enrollment period, because it doesn't need one. The state's switching rule works in two lanes:

• Plans B through N. If you have any of these (including C, F, high-deductible F and G, K, L, M and N), you can apply for any other Plan B through N from any insurer, at any time, and the insurer can't ask health questions or turn you down.
• Plan A. If you have Plan A, you can switch to another insurer's Plan A, under the same protections.

People who became eligible for Medicare on or after January 1, 2020 can't move into Plans C or F, because federal law closed those plans to them.

Two practical rules: you have to cancel the old policy once the new one starts, and you shouldn't cancel the old one until the new insurer has approved you and given you an effective date. Our switching guide walks through the timing.

Switching from coverage that isn't Medigap, such as an employer plan, can involve a health questionnaire unless you're in a guaranteed-issue situation (below).

Pre-existing condition waiting periods

Federal law lets a Medigap policy exclude a pre-existing condition for up to six months. Washington caps it at three months (RCW 48.66.130), and it defines a pre-existing condition narrowly: something you got advice or treatment for in the three months before your coverage started.

If you're replacing a Medigap policy or other coverage that was in force for at least three months, there's no waiting period at all. The state chart shows which insurers apply a waiting period at all; many don't.

Your Medigap open enrollment

Your best window to buy is the six months starting with the month you're 65 or older and enrolled in Part B. During that time an insurer can't deny you, charge you more or delay coverage because of your health (RCW 48.66.025). If you delay Part B because you're still covered by an employer plan, the window starts when Part B starts.

Guaranteed-issue rights

Outside your open enrollment, you still can't be turned down in these situations, as long as you apply within the deadline (usually 63 days after the old coverage ends):

• Your employer or union group coverage ends.
• Your Medicare Advantage plan leaves your area or stops offering coverage, or you move out of its service area.
• You joined a Medicare Advantage plan when you first got Medicare and want to leave within the first year (the "trial right").
• You dropped a Medigap policy to try Medicare Advantage for the first time and want to return within a year.
• Your Medigap insurer goes bankrupt, or ends your coverage through no fault of yours.
• Your insurer misled you or broke the rules.

People under 65

Washington is one of the states that does not require insurers to sell Medigap to people on Medicare because of a disability or end-stage renal disease. On the current state chart, only two options exist. See Medigap under 65 in Washington.

The 30-day free look

Every Washington Medigap policy must let you return it within 30 days of delivery for a full premium refund (RCW 48.66.120). That's another reason to keep your old policy until the new one is in hand.

If you're declined: WSHIP

Washington's high-risk pool, WSHIP, sells a Medicare Supplement plan to some people who were turned down by Medigap insurers for health reasons. Eligibility depends partly on whether your county has a reasonable choice of Medicare Advantage plans. See if you're turned down for Medigap.

The state-sponsored HCA plan

The Washington Health Care Authority offers a Premera Blue Cross Plan G to state residents, with no health questions, during specific enrollment windows. It appears on the state chart with one of the lowest Plan G premiums. See the HCA Premera Plan G.

Free help from the state

SHIBA, the Office of the Insurance Commissioner's Statewide Health Insurance Benefits Advisors, gives free, unbiased Medicare counseling: 1-800-562-6900.