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. If you apply for a Medigap policy and you don’t have these rights, your application undergoes medical underwriting.
You may pay a higher premium or be turned down altogether because of your health. This leaves you vulnerable when you need coverage most.
Medicare Supplement Guaranteed Issue
Everyone has Medicare Supplement guaranteed issue rights for a six-month period 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 after you’re enrolled in Medicare Part B and 65.
If your birthday is August 3rd and your Medicare Part B effective date was August 1st, you have guaranteed issue rights from August 1st through the end of January.
During this time period, you can enroll in a Medicare Supplement plan without going through medical underwriting.
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.
Medigap Guaranteed Issue Rules
As long as you are enrolled in Original Medicare Parts A and B, you can buy a Medicare Supplement.
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 Special Enrollment Period, your given guaranteed issue rights.
Below are a few examples of Medicare Supplement guaranteed issue rules.
Trial Rights if You Enroll in Medicare Advantage
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 can change. You have guaranteed issue rights for a Medigap policy.
Your rights vary depending on 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
- 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.
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:
- Your Medicare Advantage plan is leaving the area or leaving Medicare
- Moving out of the plan’s service area
- An employer plan (including a retiree plan) that supplements Medicare is ending
- Losing your Medigap coverage through no fault of your own, such as when your Medigap insurer goes bankrupt
- You move out of the area for your MedicareSELECT
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 date:
- your coverage ends
- you were notified that coverage was ending
- or the date 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.
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.
In addition, 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. This gives residents the opportunity to always 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 keep the termination letter.
Plan G is NOT a Guaranteed Issue Plan
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 happen to be declined, you can still use your GI window to apply for one of the other plans, A, B, C, F, K or L.
Can You Be Turned Down for Medicare Supplemental Insurance
No, as long as you’re within your Open Enrollment Period and/or 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
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