All Medicare beneficiaries are protected by law from unfair medical underwriting. Guaranteed issue rights prohibit insurance companies from denying or overcharging you a Medigap policy, regardless of any pre-existing health conditions. It is also referred to as “Medigap protection.”
Below we will break down how guaranteed issue rights work according to different scenarios and everything you need to know if you are faced with losing coverage.
What are Medicare Guaranteed Issue Rights?
There are a handful of instances in which you are eligible for guaranteed issue rights with Medicare plans. They usually occur when you lose coverage for reasons out of your control or because you move. You are entitled to know about all of your Medicare rights and protections.
Scenarios That Grant You Guaranteed Issue Rights:
- Trial rights when you enroll in Medicare Advantage or drop your Medigap coverage
- Your Medicare Advantage plan is leaving your specific area or leaving Medicare
- You decide to move out of the plan’s service area
- An employer plan that supplements Medicare ends
- The Medicare company did not follow the rules
Medicare Advantage Trial Rights
- When you enroll in Medicare Advantage when first become eligible for Medicare
- Switching from Medigap to Medicare Advantage for the first time
Once you become eligible for Medicare at 65, you are given a 12 month trial with Medicare Advantage. If you change your mind, you can return back to Original Medicare. The same rule applies if you enroll in a Medicare Advantage plan after turning 65. If you start with Original Medicare and a Medigap plan, you have 12 months to try Medicare Advantage.
Your trial right is similar if you leave an Advantage plan, return to Original Medicare, and then re-enroll in the same Medigap plan you had before.
Medicare Advantage Plan Discontinues According to my Zip Code
Life can be unpredictable, and it is important to understand how your zip code affects your Medicare Advantage plan. Notify Medicare of your move as soon as possible. Here are two real-life examples that can affect your coverage.
- If you move out of your plan’s service area, you will lose coverage. As a result, you will be given a guaranteed-issue right to purchase a Medicare supplement plant in your NEW area. Your second option: choose a new Medicare Advantage plan.
- Another common situation is a Medicare Advantage plan folding or being terminated in your area. This will result in you losing coverage, however, you will not be at fault.
What if My Medicare Advantage Plan Suspends My Coverage?
If the company you are currently insured with is discontinuing your coverage, you need the following documents to qualify for a plan change:
- You must have a dis-enrollment letter from your insurance provider
- The date your coverage ends
- The applicant name must be on the documentation
Now that you qualify, you can select a Medigap policy and avoid the health questions, guaranteeing coverage.
What if My Employer Plan That Supplements Medicare is Ending?
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 an employer plan is ending, you must apply for Medigap no later than 63 days.
Those that have COBRA can either wait until COBRA ends or buy a Medigap plan right away.
What if I Involuntary Lose Group Coverage?
If you involuntary lose group coverage, this means your insurer is dropping your plan, although it is not your fault. This also includes the insurance company filing 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, then you may qualify for guaranteed issue supplemental insurance.
What if I’m Voluntarily Losing Group Coverage?
If you are voluntarily losing group coverage, you are choosing to leave your carrier. When you talk to an agent, you should be ready to send the following information to the insurance company:
- The date that the coverage ends
- Documentation must be on your employer or carrier letterhead
- You must indicate if 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, you may qualify for guaranteed issue rights for a new policy. You may need to file a complaint with Medicare.
Medigap Guaranteed Issue Rights by State
In Maine, with no gaps in coverage for longer than 90 days since you first signed up for a Supplement, you have a guaranteed issue right to switch your plan. Also, carriers in Maine MUST offer Plan A to any enrollee that applies during a 30-day window each year.
So, if you want to change your current supplemental plan to a different one, you’ll qualify. Of course, with any plan change, you need documents.
You will need the following documents for a supplement to supplement policy:
- Copy of 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
If you have no coverage with your Medicare or a Medicare Advantage plan, you may need to go through medical underwriting.
Medicare Supplement Guaranteed Issue States with The Birthday Rule
Oregon and California have “Birthday Rules,” allowing Medigap enrollees 30-days to change plans. The California birthday rule and Oregon birthday rule allow a switch to another Medigap plan with the same or lesser benefits, without medical underwriting. States with annual guaranteed issue periods still require documents to change.
The documents you need include:
- A copy of your current Medicare supplement ID card with your current plan letter a full name
- Proof of payment for the past three months
Medigap Guaranteed Issue States: Policy Anniversary Rule
In Missouri, the Anniversary Guaranteed Issue Period allows anyone with a Supplement plan 60-days to change plans. The window allows you to switch to the same policy from any other carrier, without underwriting. The anniversary rule means that a new company must sell you the policy you apply for regardless of any pre-existing conditions.
Meaning, you get to shop coverage each year and compare premiums.
You’ll need the following documents:
- Copy of a report from your current provider showing your policy anniversary, plan letter, and full name.
- Proof of payment for the past three months which must include your name
Guaranteed Issue Rights with Loss of Medicaid
Advantage guidelines for guarantee issue rights do not apply to Supplements. Depending on your state, if you lose Medicaid, you may or may not qualify for guaranteed acceptance in a supplement. If under 65, depending on your state waiting until the 65th birth month for the Supplement Open Enrollment Period is possible.
Either way, when you apply for new coverage, you will need:
- Medicaid termination letter
- The date that coverage ends/ended
- An applicant’s name on the document
Which Medicare Supplement Plans are Guaranteed Issue?
How to Get Help Understanding Guaranteed Issue Rights
There are many reasons you qualify for guaranteed Iissue rights. Whether you're new to Medicare or you've been around the Medicare block, having an expert in your corner can make a difference.
First, an agent will ask you a few questions about your plan now, including your likes and dislikes. Then, they answer all your questions.
Give us a call at the number above to see the options available in your area. Or, fill out an online rate comparison form and learn which options could be better for your situation!