Medicare Supplement Guaranteed Issue rights mean that insurance companies can’t turn you down due to health issues. Insurers must cover pre-existing health conditions, and they can’t charge extra because of them.
It’s important to know when Guarantee Issue rights begin. If you apply for Medigap without these rights, the application goes through underwriting.
You may pay a higher premium or receive a denial because of your health.
Medicare Supplement Guaranteed Issue Rights
Everyone has Medigap Protection rights for six months around the time they turn 65. Guaranteed Issue rights are not the same as your one time Medicare Supplement Open Enrollment Period.
Your OEP begins on the first day of the month you’re Part B begins, and you’re 65.
If your birthday is August 3rd and the Part B effective date is August 1st, GI rights last from August 1st through the end of January.
During this period, you can enroll in a Medicare Supplement plan without going through medical underwriting.
If you miss your OEP, some circumstances allow you to get a Guaranteed Issue. You can find detailed information on all the different types of Medicare enrollment periods here.
As long as you have Medicare Parts A and B, you can buy a Supplement.
These plans are through private insurers who may charge different premiums for the same coverage.
As long as you apply during your OEP or a Special Enrollment Period, you get Medigap Protection rights.
The 7 Guarantee Issue rights with Medicare Supplements are:
- Trial Rights when you enroll in Medicare Advantage
- Trial rights when you drop Medigap
- Your Medicare Advantage plan is leaving the area or leaving Medicare
- Moving out of the plan’s service area
- An employer plan that supplements Medicare is ending
- Losing your Medigap coverage through no fault of your own, such as when your Medigap insurer goes bankrupt
- The Medicare Company Didn’t Follow the Rules
Trial Rights if You Enroll in Medicare Advantage
Everyone gets a 12 month 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 Medicare, you can change. Also, you’ll have Guaranteed Issue Rights for a Medigap policy.
If you chose the Medicare Advantage when you turned 65 and switch to Medicare within the first year, you could choose any Medigap plan in your area.
Trial Rights For Dropping Medicare Supplements
Those that switch from Medigap to Medicare Advantage and now want to switch back have a GI right to buy the same policy as before; if your old insurance company still sells it. If the previous plan isn’t available, you may purchase another Medigap policy that’s sold by any insurance company.
You must apply for Medigap at least as early as 60 days before the date coverage ends but not later than 63 days. Rights may last up to 12 months under particular circumstances.
Your Medicare Advantage Plan is Leaving the Area or Leaving Medicare
When you lose coverage through no fault of your own, you have the right to switch to a Medigap plan rather than another Medicare Supplement.
In this case, your Guaranteed Issue right allows you to buy Plans A, B, C, F, K, or L. You only have this right when you go to Medicare instead of another advantage plan.
As early as 60 calendar days before the policy ends, you can apply for new coverage; however, after 63 days, it’s too late. Medigap can’t start until Medicare Advantage ends.
Moving Out of the Plan’s Service Area
Some beneficiaries have a Medicare Select or Medicare Advantage plan that requires recipients to stay in the service area. When you move out of the service area for your policy, you qualify for Guaranteed Issue Rights.
Having coverage in the place you live in is essential. Notify Medicare of your move as soon as possible.
Just like when the plan leaves the service area, you have 63 days to get coverage before it’s too late.
An Employer Plan That Supplements Medicare is Ending
If your employer plan is ending, you must apply for Medigap no later than 63 days after the date coverage ends, the notification of coverage was concluding, or the time on a claim denial
You can apply for Medigap starting 60 days before you lose coverage, and your Guaranteed Issue right ends 63 days after you lose coverage.
If you have COBRA, you can either wait until the COBRA coverage ends or buy a Medigap plan right away.
Losing Your Medigap Coverage Through No Fault of Your Own
When you lose coverage due to non-payment, the insurance company considers that your fault. However, if your company goes bankrupt, that’s not your fault.
In cases where the Medicare Supplement coverage is ending through no fault of our own, Guaranteed Issue rights will apply.
A Medicare Company Didn’t Follow the Rules
If a company misleads you or doesn’t follow the rules, you may qualify for Guaranteed Issue rights for a new policy. You may need to file a complaint with Medicare.
Complaints could include a limiting number of specialists in the network.
Medicare Supplement Guaranteed Issue State Policy
In Maine, as long as you haven’t had any gaps in coverage for longer than 90 days since you first signed up for a Medicare Supplement, you have Guaranteed Issue right to switch your plan to one of equal or lesser value.
Also, carriers in Maine MUST offer Plan A to any enrollee that applies during a 30-day window each year.
Medicare Supplement policies are Guaranteed Issue year-round in the following state:
In Missouri, you can change to another carrier, as long as it’s the same letter plan, for a lower price once per year on its anniversary.
The birthday rule means that each year, for 30 days after your birthday, you can change to another Medicare Supplement plan of equal or lesser value without going through medical underwriting. The birthday rule allows residents always to have the lowest premiums available.
Additional Medicare Supplement Guaranteed Issue Guidelines
Keep Your Creditable Coverage Letter
When your employer coverage ends, make sure to keep the creditable coverage letter from your prior insurance carrier. If you had a Medicare Advantage plan that you left or lost, make sure to follow the termination letter.
Plan G is NOT a Guaranteed Issue Plan
Unless you became eligible for Medicare after 2020, Plan G is NOT one of the plans you can choose under Guaranteed Issue when you’re losing coverage.
However, if you can pass the health questions, it won’t hurt to apply. If you get a decline, you can still use your GI window to apply for one of the other plans, A, B, C, F, K, or L.
Those eligible after 2020 can use GI rights to select Plan G. In 2020; Plan G becomes a GI policy for newly eligible beneficiaries.
What Medicare Supplement Plans are Guaranteed Issue
Beneficiaries eligible for Medicare before 2020 won’t be eligible to enroll in Plan D or Plan G with Guarantee Issue rights when losing coverage. However, Plan C and F will be available to these beneficiaries.
What is the difference between Open Enrollment and Guaranteed Issue
In general Open Enrollment is a one-time 6-month window when you can purchase any Medigap policy available in your state. You cannot be denied due to any health issues or charged higher premiums.
Guarantee Issue Rights you get under certain situations. An example is when you lose other health coverage.
Can You Be Turned Down for Medicare Supplemental Insurance
No, as long as you’re within your Open Enrollment Period and have Guaranteed Issue, a carrier cannot turn you do for a Medigap plan.
You can see other situations where Guaranteed Issue applies on Medicare.gov.
Talk to a Medicare Supplement Agent Today
At MedicareFAQ, we work with top-rated insurers to make sure you get the right coverage that fits your healthcare needs with the best rates. Our Client Care Team will also be available to you throughout the lifetime of your policy. If you have any claim issues, they can help.
To compare rates in your area, give us a call or complete our online rate form.