Medicare Supplement guaranteed issue rights mean that insurance companies can’t turn you down for a Medicare Supplement, or Medigap, policy. Insurers must cover your pre-existing health conditions and cannot charge you extra because of them.
It’s important to know when you have guaranteed issue rights because if you apply for a Medigap policy and you do not have these rights, your application may go through the medical underwriting process. You may pay a higher premium or be turned down altogether because of your health. This leaves you vulnerable just when you need coverage the most.
Medicare Supplement Guaranteed Issue Rights
Everyone has Medicare Supplement guaranteed issue rights for a six-month period around the time they turn 65. You are given guaranteed issue for Medicare Supplement coverage if you apply during your Open Enrollment Period. Your OEP begins the first day of the month after you turn 65 years old and are enrolled in Medicare Part B. For example, if your birthday is August 3rd and your Medicare Part B effective date was August 25th, you have guaranteed issue rights from September 1st through the end of February. If you miss your OEP, there are some circumstances that allow you to still be given guaranteed issue. You can find detailed information on all the different types of Medicare enrollment periods here.
Medicare Supplement Guaranteed Issue Rules
As long as you are enrolled in Original Medicare Parts A and B, you can buy any Medicare Supplement, or Medigap policy, that’s offered in your area. There are 10 standard plans, labeled Plan A through Plan N. These plans are offered through private insurers who may charge different premiums for the same coverage. As long as you apply during your OEP or granted a SEP as explained above, your given guaranteed issue rights. Below are a few examples of Medicare Supplement guaranteed issue rules.
Trial Rights if You Enroll in Medicare Advantage and Change Your Mind
Everyone gets a one-time “free trial” of Medicare Advantage, which is Medicare coverage offered through private insurers. If you sign up for Medicare Advantage and decide within the first year that you’d rather have Original Medicare, you have guaranteed issue rights for a Medigap policy. Your rights vary depending on your situation:
- If you enrolled in Medicare Advantage when you turned 65 and switch to Original Medicare within the first year, you can choose any Medigap plan offered in your area.
- If you switched from Original Medicare and Medigap to Medicare Advantage and now want to switch back, have a guaranteed issue right to buy the same policy you had before, if your old insurance company still sells it. If not, you can buy plan A, B, C, F, K or L.
You can apply for coverage as soon as 60 days before your Medicare Advantage coverage ends, and up until 63 days after your coverage ends.
Guaranteed Issue Rights if You Have Other Coverage that Is Ending
You may also have a guaranteed issue right if you are losing other coverage that is similar to Medigap. Some of the most common examples of this include:
- You have a Medicare Advantage plan, but the plan is leaving your area or leaving Medicare, or you are moving out of the plan’s service area.
- You have Original Medicare and an employer plan (including a retiree plan) that supplements Medicare, and that plan is ending.
- You lose your Medigap coverage through no fault of your own, such as when your Medigap insurer goes bankrupt.
- You have Original Medicare and a Medicare SELECT policy, and you move out of the policy’s service area.
In these cases, your guaranteed issue right allows you to buy Plans A, B, C, F, K or L.
If your employer plan is ending, you must apply for Medigap no later than 63 days after the latest of these dates: the date your coverage ends, the date you were notified that coverage was ending, or the date on a claim denial. In any other of the above situations, you can apply for Medigap starting 60 days before you lose coverage, and your guaranteed issue right ends 63 days after you lose coverage.
Additional Medicare Supplement Guaranteed Issue Guidelines
|wdt_ID||You have guaranteed issue right if...||You have the right to buy...||You can/must apply for a Medigap policy...|
|1||You're in a Medicare Advantage plan (like HMO or PPO), and your plans leaving Medicare or stops giving care in your area, or you move out of the plan's service area.||Medigap Plan A, B, C, F, K or L that's sold in your state by any insurance company. You only have this right if you switch to Original Medicare rather than join another Medicare Advantage plan.||As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after our health care coverage ends. Medigap coverage can't start until your Medicare Advantage plan coverage ends.|
|2||You have original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plane is ending. You also may have additional rights under state law in this situation.||Medigap Plan A, B, C, F, K or L that’s sold in your state by any insurance company. If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.
||No later than 63 days after the latest of these three dates: 1. Date the coverage ends. 2. Date on the notice you get telling you that coverage is ending. 3. Stay on a claim denial, this is the only way you know that your coverage ended.
|3||You have original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy service area.||Medigap Plan A, B, C, F, K or L that's sold by any insurance company in your state or the state you're moving to.||As early as 60 calendar days before the date your Medicare SELECT coverage will end, but no later than 63 calendar days after your Medicare SELECT coverage ends.|
|4||Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.||Medigap Plan A, B, C, F, K or L that’s sold in your state by any insurance company.||No later than 63 calendar days from the date your coverage ends.|
|5||Leave a Medicare Advantage plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you.||Medigap Plan A, B, C, F, K or L that’s sold in your state by any insurance company.||No later than 63 calendar days from the date your coverage ends.|
|You have guaranteed issue right if...||You have the right to buy...||You can/must apply for a Medigap policy...|
Talk to a Medicare Supplement Agent Today
At MedicareFAQ, we’ll give you instant quotes on the Medigap plan that best meets your needs. We work with top-rated insurers to make sure you get coverage at the best possible price. Talk to a Medicare Supplement agent today to find out if you missed your OEP or are eligible for a Special Enrollment Period.