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Guaranteed Issue Medicare Supplement (Medigap) Rights by State


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.

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

Give us a call at the number above to see the options available in your area or fill out an online rate comparison form form and learn which options are best for your needs!

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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.

  1. Guaranteed issue rights, Medicare . Accessed September 2022.
    https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights
  2. 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/

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

30 thoughts on “Guaranteed Issue Medicare Supplement (Medigap) Rights by State

  1. 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?

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