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.
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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.
Guaranteed issue rights ensure this protection. Thus, it is vital to understand all your Medicare Supplement 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.
Scenarios That Grant You Guaranteed Issue 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 misled you
- 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.
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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.
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.
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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 with Loss of Medicaid
Medicare Advantage guidelines for guaranteed issue rights do not apply to Medicare Supplement plans. So, if you lose Medicaid, you may or may not qualify for guaranteed acceptance in a Medicare Supplement plan.
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 Medicare Supplement Plans Guaranteed Issue?
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:
- Medigap Plan A
- Medigap Plan B
- Medigap Plan G
- Medigap High Deductible Plan G
- Medigap Plan K
- Medigap 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.
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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.
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 at all times.
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Guaranteed issue rights, Medicare . Accessed September 2022.
https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights - Medigap Enrollment and Consumer Protections Vary Across States, KFF. Accessed September 2022.
https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/
In California, if one signs up for High G and years later decides to sign up for Plan G, is guaranteed issue still available to them during OEP or with the Birthday Rule? Thank you.
Nancy, in order to use the Birthday Rule, you need to switch to a plan that is of equal or less benefit than your current plan. So, you would not be eligible to switch from HD-G to standard G.
Hi Jagger, I live in California receiving full MediCal (Medicade), I will be a Medi-Medis (MediCare + MediCal as secondary) next month April 2022. I expect to lose my MediCal in 1 year when I start collecting social Security.
Question: Do I still have [Guaranteed Issue Right] to purchase a Supplemental Plan when I no longer have MediCal?
Thank you for reaching out. If you lose MediCal benefits, you will be eligible for Guaranteed Issue Rights for a Medicare Supplement plan.
In Arkansas and turning 65 in March, 2022. What are my guaranteed issue rules ?
Jack, when turning 65 you are entitled to an Open enrollment period which allows you to enroll in any plan you wish with no consideration for pre-existing conditions.
I am retired, living in Kentucky, and I currently have a managed indemnity plan through my former employer in Ohio. For 2022, the plan is being replaced with a custom group Medicare Advantage plan. Do I have guaranteed issue rights to move from the employer plan to a medigap plan without underwriting?
Mary, if you drop your current employer plan, you will have a 63-day window to enroll in a Medigap using guaranteed issue rights.
I live in Washington State where we have year-round guaranteed-issue when switching Medigap policies. I turned 65 last July and signed up with a Medicare Advantage plan, so I’m still within the 12 month “trial period”. If I choose to switch to a Medigap plan after my 12-month trial period ends, do I have the same year-round guaranteed-issue rights or does that only apply when switching between Medigap policies?
Hi Ken – year-round guaranteed issue applies regardless of your previous coverage.
Hi Jagger, I live in Oregon and currrently have Plan F. I understand that this plans rates will be climbing because of the inability of most new Medicare enrollees to select this plan. If I were to chose Plan G during Open Enrollment, could I be rejected by ANY of the Providers due to my high usage of my insurance? Could I also switch 30 days before and 30 days after my birthday anniversary? Thanks, Jagger.
Hi Lee – because you live in Oregon, you can change to Plan G during your 61-day birthday rule window. This protects you from rejection, regardless of your health.
Is Massachusetts a Guaranteed Issue state? If so, does the Medicare Massachusetts Guaranteed Issue provision allow Massachusetts residents enrolled in a Medicare Advantage Plan move to a Medicare Supplemental Plan during the annual open enrollment period without consideration to prior medical history?
Hi Richard – Massachusetts is one of three states with guaranteed issue Medigap plans and continuous open enrollment. Thus, there is no need for medical underwriting.
For unknown reason, I see no mention of CA guaranteed issue (trial right) that applies to one who has an advantage plan at turning 65, and within first 12 months decides to change to a orig. medicare and medigap policy. The window period spans 123 days, starting 60 days before birthday to 63 days after birthday, in which to have applied for medigap policy after notifying medicare to change from an advantage plan to original medicare.
This brings up a following question from what is vaguely explained above. Can a person still retain guaranteed rights (no underwriting and price protection too) if they retain the advantage plan for say two years, before deciding to change to orig. medicare and a medigap policy?
Looking here for some specifics as the devil is in details. Thanks.
Hi Tom! I believe you’re referring to the California Birthday rule where you have 30 days before & 30 days after your birthday to enroll in a Medigap plan without health conditions being a factor. Some carriers will allow you to enroll up to 60 days after your birthday. The birthday rule ONLY applies to those enrolled in a Medigap plan. Not Medicare Advantage. The trial rights discussed on this page are only for 12-months. If you keep your advantage plan longer than 12-months you will no longer be eligible for trial rights.
I live in Ohio and my birthday is in January, Can I switch from F to G without suffering any big issues?
Hi Robert! You can switch Medigap plans at any time of the year. You’ll have to go through medical underwriting when you switch from Plan F to Plan G. As long as you don’t have any health issues, you shouldn’t have a problem switching. You can read more about Ohio Medigap here.
When can you be eligible for guaranteed issue rights if you voluntarily lose supplemental employer coverage? We are in California and my husband has original Medicare (primary) and coverage through my employer plan (secondary). I pay $1,200 per month for this supplemental coverage and this is becoming a financial hardship for us.
The California guidelines for voluntary group termination states that as long as your employer plan is primary to Medicare, you will have Guaranteed Issue Rights for 63 days. Let me know if you have any more questions!
I am in Texas. If I have had a Medigap policy Plan G in place since 9/1/2020 with one carrier, can I switch to a Plan G with another carrier as a guaranteed issue with a 12/1/2020 effective date.
Hi Amanda! If you’re still within your 6-month open enrollment period or qualify for a Special Election Period, then yes. Outside one of those two enrollment windows, you won’t be eligible for Guaranteed Issue Rights. Texas follows the normal open enrollment guidelines.
Hi. This is related to the comment above about losing Medicaid coverage. Could you tell me if North Carolina has guaranteed issue rights for supplemental coverage with the loss of Medicaid coverage (my mom had medicaid since age 65). I can’t find this information anywhere. Thanks!
Hi Tom! Unfortunately, I don’t believe North Carolina has Guaranteed Issue Rights for those who lose Medicaid. We have a great FAQ on Medicare & Medicaid coverage that may help answer your question.
My mother has always had Medicare and Medicaid. She recently lost her Medicaid because her income is too high. Her health is not good. Does she have guaranteed issue for a Medicare Supplement? If no, can she enroll in a Medicare Advantage Plan and drop it within one year and have guaranteed issue for a Medicare Supplement? She is over 65 and lives in VA.
Hi Sally! Unfortunately no, in Virginia she would not have Guaranteed Issue Rights due to losing Medicaid coverage. In other states, she may have. Regarding Trial Rights, they only apply if she had a Medigap plan from the time she turned 65 & later decided to enroll in a Medicare Advantage Plan. I hope this helps!
I am having difficulty getting a letter from my current carrier that they are ending their plan F at the end of the year. How do I take advantage of guarenteed issue without the letter? What can I do to get a letter? The insurance company has no idea what I’m talking about & asked me what should be in the letter. Suggestions? If I want to choose a plan G going forward, does that mean underwriting?
Hi Jane! Are you sure your carrier is dropping Plan F? You may be confusing the MACRA changes. Plan F is only going away to those who are not eligible until after 2020. Current beneficiaries will not be impacted by these changes. Your Plan F will still be offered by your carrier. That’s probably why they’re not giving you a letter, because they are in fact still offering that plan to you. Also, Plan G is not a Guaranteed Issue plan. This means that even if you had GI rights, you could not use them to enroll in Plan G since your considered Medicare eligible prior to 2020. Hopefully, this helps!
Is there an addendum or a recent notice for a guaranteed right to buy a Medicare supplement insurance plan at the time of a birthday month this year?
Hi Tom, great question! What you’re referring to is called the birthday rule. As of now, only California and Oregon have this rule. You can find more state-specific Medicare rules here.