Guaranteed Issue Medicare Supplement

Summary: Guaranteed Issue Medicare Supplement rights can help protect you against loss of coverage and medical underwriting. Learn more about your GI rights for Medicare Supplement plans and which states they’re available in. Estimated Read Time: 11 mins

Table of Contents:

1. 1. What Does Guaranteed Issue Mean?
   2. What is Guaranteed Issue for Medicare Supplement?
   3. What If My Medicare Supplement Plan Suspends My Coverage?
   4. What If My Employer Plan That Supplements Medicare is Ending?
   5. What If My Medicare Carrier Didn’t Follow the Rules?
   6. Medigap Guaranteed Issue Rights by State
   7. Guaranteed Issue Rights and Open Enrollment Periods
   8. Guaranteed Issue States for Medicare Supplement
   9. Buying a Medigap Plan Outside of a Protected Enrollment Period
   10. Guaranteed Issue Rights with Loss of Medicaid
   11. Are There Guaranteed Issue Medicare Supplement Plans?
   12. Are Medicare Advantage Plans Guaranteed Issue?
   13. Medicare Trial Right
   14. Are Medicare Supplement Plans Guaranteed Renewable?

There are a few situations when you can enroll in a Medicare Supplement (Medigap) policy without answering underwriting health questions outside your Medicare Supplement Open Enrollment. One instance is when you are using guaranteed issue rights.

When you must go through the underwriting process, there is a chance you may face denial due to pre-existing health conditions. Thus, knowing when you can bypass answering these questions is essential.

Below, we explain how guaranteed issue rights work according to different scenarios and everything you need to know if you face losing coverage and wish to enroll in a Medigap plan.

What Does Guaranteed Issue Mean?

Guaranteed issue means that an insurance company cannot refuse you a Medicare Supplement plan for any reason. So, if you have guaranteed issue rights, you will not need to answer underwriting health questions.

If you get guaranteed issue rights due to a particular circumstance, it is vital to utilize the enrollment window, as it may not happen again. Not everyone who enrolls in Medicare will get guaranteed issue rights. Additionally, a guaranteed issue right will only last for a limited time.

What is Guaranteed Issue for Medicare Supplement?

Also known as Medigap protections, guaranteed issue rights prohibit insurance companies from denying coverage or overcharging you for a Medigap policy, regardless of pre-existing health conditions. The law protects those on Original Medicare from unfair medical underwriting.

Medigap guaranteed issue rights ensure this protection. Thus, it is vital to understand all your Medicare Supplement guaranteed issue rights and protections and when you may utilize guaranteed issue rights.

There are a handful of instances where you can use guaranteed issue rights. They usually occur when you lose coverage for reasons beyond your control, if you use a trial right, or because you move out of your policy’s coverage area. These are the minimum federal standards for Medigap GI rights that you’re entitled to in all 50 states and Washington D.C.

Medicare Supplement GI Rights:

• You leave a Medicare Supplement plan to join a Medicare Advantage plan for the first time, have been in the plan less than a year, and wish to go back to Medicare Supplement (trial right)
• You joined a Medicare Advantage Plan at age 65 and want to switch from Medicare Advantage to a Medicare Supplement plan during the first year (trial right)
• Your Medicare Advantage plan is dropping coverage in your area, or you move out of the plan service area
• You have Medicare SELECT and decide to move out of the plan’s service area
• Your employer plan that supplements Medicare ends
• The Medicare company did not follow the rules or gave you misleading information
• Your Medicare Supplement insurance company goes bankrupt

What If My Medicare Supplement Plan Suspends My Coverage?

It is unlikely for a Medicare Supplement insurance company to suspend your coverage. However, if your current insurance company is discontinuing your coverage, you need the following information to qualify for a plan change with a guaranteed issue right:

• A disenrollment letter from your insurance provider
• The date your coverage ends
• The applicant’s name on the documentation

Once you qualify, you can select a Medicare Supplement policy to enroll in with any carrier you wish and avoid the health questions, guaranteeing coverage.

What If My Employer Plan That Supplements Medicare is Ending?

If you receive communication from your employer that your health insurance coverage is ending, you may apply for a Medicare Supplement plan starting 60 days before you lose coverage, and your guaranteed issue right ends 63 days after you lose coverage. Thus, if an employer plan ends, you must apply for Medigap no later than 63 days following the loss of coverage to avoid medical underwriting.

Those with COBRA can either wait until their COBRA coverage ends or buy a Medicare Supplement (Medigap) plan immediately.

Voluntary vs Involuntary Loss of Coverage

There are different Medicare Supplement guaranteed issue rights if you voluntarily get rid of your coverage or if you lose coverage through no fault of your own. It’s vital to know about these differences so that you know what your next steps are in obtaining the health coverage that you need.

What If I Involuntarily Lose Group Coverage?

When your insurer drops you from your plan, it is an involuntary loss of group coverage. This includes if the insurance company files for bankruptcy.

Involuntary means you did not cancel the coverage, nor are you losing coverage for non-payment. If you are losing group coverage involuntarily, you may qualify for guaranteed issue supplemental insurance.

What If I’m Voluntarily Losing Group Coverage?

If you are voluntarily losing group coverage, you choose to leave your carrier. When you talk to an agent about enrolling in a new plan, you should have the following information:

• The date that the coverage ends
• Documentation on your employer or carrier letterhead
• Indication of whether the coverage is primary or secondary

What If My Medicare Carrier Didn’t Follow the Rules?

If a company misleads you or does not follow the rules for Medicare Supplement plans, you may qualify for guaranteed issue rights for a new policy. However, you may need to file a complaint with Medicare. Upon approval of your appeal, you will get a guaranteed issue right to enroll in new coverage.

Medigap Guaranteed Issue Rights by State

Certain states have special guaranteed issue rights that impact their policyholders. Each of these state-specific rules allows beneficiaries an opportunity to change Medigap plans without underwriting.

When utilizing these state-specific guaranteed issue rights, you must provide the necessary documentation for a smooth transition.

You will need the following documents for a Medigap-to-Medigap policy change:

• A copy of your current Medicare Supplement ID card with your current plan letter and your name
• Proof of payment for the past three months, which must include your full name

You will need the following documents for a Medicare Advantage-to-Supplement policy change:

• Proof of disenrollment
• Policy end date

You may require medical underwriting if you do not yet have coverage through a Medicare Supplement or Medicare Advantage plan.

Guaranteed Issue Rights and Open Enrollment Periods

Guaranteed issue rights are protections for Medicare enrollees in certain situations. These rights prevent insurance companies from denying enrollment in certain Medigap policies when beneficiaries meet specific criteria.

To utilize Medicare guaranteed issue rights, beneficiaries must abide by MACRA when selecting their plan. At this time, only those who got Medicare Part A before January 1, 2020, can sign up for Medicare Supplement Plan F or Medicare Supplement Plan C.

Like Open Enrollment Periods, guaranteed issue rights let you enroll in a Medigap plan with no Medicare Supplement underwriting questions. Individuals with Medicare since before January 1, 2020, may enroll in any Medigap plan they wish.

Guaranteed Issue States for Medicare Supplement

Some states have further guaranteed issue protections beyond the minimum federal rules.

Annual Medigap Guaranteed Issue States

Missouri and Washington are two of the most notable states that offer additional guaranteed issue rights for those on Medigap plans.

• Missouri – Policyholders may change from like-to-like benefits during a 62-day period beginning 30 days before the annual policy anniversary and ending 30 days after.
• Washington – Policyholders may change from like-to-like or like-to-lesser benefits year-round.

No Health Underwriting Year-Round

Four states offer continuous or annual open enrollment to traditional Medicare beneficiaries aged 65 and older. These four states never require you to undergo the underwriting process. Thus, you cannot face denial form a policy due to pre-existing conditions. The four states are:

• Connecticut
• Maine – Open Enrollment only in the month of June
• New York
• Vermont – Open Enrollment only for plans with United Healthcare and Mutual of Omaha

Medicare Supplement Birthday Rules

Other examples are the eight states with Medigap Birthday Rules. These states include: California, Oregon, Idaho, Illinois, Louisiana, Maryland, Nevada, and Oklahoma. These birthday rules typically state that you can switch to a different Medicare Supplement plan of lesser or equal value between 30-60 days of your birthday. If you live in a state with a birthday rule, check your state rule’s guidelines for more information.

Other Guaranteed Issue Medigap Rights for States

Furthermore, there are 28 states that have state-specific guaranteed issue protections alongside federal protections that are limited to qualifying events in that state. These 28 states require Medigap insurance companies to issue a policy even when an applicant has an involuntary change in their employer retirement coverage. This is different from the federal minimum Medigap guaranteed issue right which only applies when employer coverage is eliminated altogether.

Buying a Medigap Plan Outside of a Protected Enrollment Period

If you try to purchase a Medicare Supplement Plan outside of a protected enrollment period, you may have trouble getting coverage. Insurers can deny you coverage or charge higher monthly premiums based on pre-existing conditions.

You may also be subject to a six-month waiting period before your Medigap plan will cover any medical treatment related to any pre-existing conditions. It’s important to contact any Medigap carriers in your area to see if they will sell you a Medicare Supplement policy outside of a protected enrollment period or any conditions they may impose.

Do I Have the Right to Cancel My Medigap Policy?

You can review a new Medigap plan for the first 30 days of enrollment. You can cancel it within those 30 days for a full refund if it doesn’t meet your health coverage needs.

You can also cancel your Medicare Supplement plan any time after those first 30 days. However, it’s important to keep in mind that if you cancel after 30 days, there may be conditions depending on where you live. You may not be able to purchase another Medigap plan, or you may be subject to medical underwriting and thus get charged more due to your health.

Guaranteed Issue Rights with Loss of Medicaid

If you lose Medicaid, you may or may not qualify for guaranteed acceptance in a Medicare Supplement plan.

There are currently nine states that offer guaranteed issue rights if you lose Medicaid eligibility. These states include California, Kansas, Maine, Montana, Oregon, Tennessee, Texas, Utah, and Wisconsin.

Ultimately, whether you qualify depends on the state where you live. If you are under 65, you can wait until your 65th birthday month. Then, you may utilize your Medicare Supplement Open Enrollment.

When you apply for new coverage, you will need:

• Your Medicaid termination letter
• Coverage end date
• The applicant’s name

Are There Guaranteed Issue Medicare Supplement Plans?

The plans for which you may use guaranteed issue depend on the date your Original Medicare coverage began. When utilizing guaranteed issue rights, beneficiaries must follow MACRA.

This means those who enrolled in Original Medicare before January 1, 2020, are only eligible for a guaranteed issue right for the following plans:

• Medicare Supplement Plan A
• Medicare Supplement Plan B
• Medicare Supplement Plan C
• Medicare Supplement Plan F
• Medicare Supplement High Deductible Plan F
• Medicare Supplement Plan K
• Medicare Supplement Plan L

Conversely, those who enrolled in Original Medicare after January 1, 2020, can enroll in the following:

• Medicare Supplement Plan A
• Medicare Supplement Plan B
• Medicare Supplement Plan G
• Medicare Supplement High Deductible Plan G
• Medicare Supplement Plan K
• Medicare Supplement Plan L

Note that those on Original Medicare before January 1, 2020, are not eligible to enroll in Medicare Supplement Plan G using guaranteed issue rights. If you were on Medicare before that date, you must undergo medical underwriting if you wish to enroll in Medigap Plan G.

Are Medicare Advantage Plans Guaranteed Issue?

Medicare Advantage plans will never require underwriting health questions to enroll. So, in a sense, all Medicare Advantage plans are guaranteed issue. However, not in the same way as a Medicare Supplement plan.

Medicare Advantage plans will allow any person with any health condition access to health coverage. However, you must consider potentially higher out-of-pocket costs than a Medicare Supplement plan. Additionally, it is crucial to understand that your Medicare Advantage plan may have a network of doctors and hospitals you must use. Remember, when enrolling in a Medicare Advantage plan, you must be in a valid Medicare Advantage enrollment period. You cannot enroll at any time.

So, while you do not need to answer underwriting health questions when enrolling in a Medicare Advantage plan, you may not receive the perks that come with enrolling in a Medicare Supplement plan.

Medicare Trial Right

If you enroll in a Medicare Advantage plan during your Initial Coverage Election Period when you were first eligible for Medicare, you are entitled to a 12-month Medicare Advantage trial right period. During this 12-month window, you have a Special Enrollment Period you can use at any time to cancel your Medicare Advantage plan and return to Original Medicare.

At the same time, you’ll have a guaranteed issue right to enroll in a Medicare Supplement plan. The guaranteed issue right will last for 63 days after you disenroll from your Medicare Advantage plan.

This same trial right applies to those who drop a Medicare Supplement plan and enroll in a Medicare Advantage plan for the first time.

In this scenario, you also get a 12-month window offering you a Special Enrollment Period to change your mind. Once you disenroll from your plan, you have 63 days to re-enroll in a Medicare Supplement with guaranteed issue rights.

Still, this trial right has limits. You can only re-enroll in your previous Medicare Supplement plan if it is still available in your area. So, if your plan’s premium goes up, you will be responsible for the change in cost.

Are Medicare Supplement Plans Guaranteed Renewable?

Yes, according to CMS, any Medigap policy is guaranteed renewable as long as you continue to pay your monthly premium. This means that your Medicare Supplement plan carrier can’t cancel your policy even if you have health issues. Once you enroll in a Medigap plan you can stay on that plan with the same insurance company as long as you wish.

How to Get Help Understanding Guaranteed Issue Rights

Whether you are new to Medicare or you enrolled years ago, understanding enrollment windows is essential to ensuring you have the best coverage for your healthcare needs.

Our licensed insurance agents are ready to help you compare your coverage options to help you choose the best Medicare coverage possible.

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