Close close icon

7 Guaranteed Issue Rights with Medicare

Medicare Guaranteed Issue Rights mean that carriers must approve your application regardless of your current health or medications. You may need to provide documents to prove you’re eligible. Below we’ll discuss Guarantee Issue Rights, necessary documents, and various state rules.

Medicare Guaranteed Issue Rights

There are seven instances when you’re eligible for Guarantee Issue Rights with Medicare plans. These include trial rights, involuntary loss of coverage, and other situations. Having the right documents during a loss of coverage could mean you have a Guaranteed Issue right. You’re entitled to know about all your Medicare rights and protections.

7 Guarantee Issue Rights with Medicare:

  1. Trial rights when you enroll in Medicare Advantage
  2. Trial rights when you drop Medigap
  3. Your Medicare Advantage plan is leaving the area or leaving Medicare
  4. Moving out of the plan’s service area
  5. An employer plan that supplements Medicare is ending
  6. Losing your Medigap coverage through no fault of your own, such as when your Medigap insurer goes bankrupt
  7. The Medicare company didn’t follow the rules

Trial Rights if You Enroll in Medicare Advantage

Everyone gets a 12 month one-time “free trial” of Medicare Advantage, which is Medicare coverage from private insurers. You may have had employer coverage through one of the top Medicare Advantage companies.

There are strict rules to follow if you want a Medigap plan instead of Medicare Advantage. Those that enroll in an Advantage plan at age 65 have 12 months to switch coverage.

Yet, those that start with supplement coverage can switch to an Advantage plan and “try” the coverage. Either way, you can only “try” the Advantage for 12 months at most. After 12 months, you no longer qualify for “trial rights.”

Further, when you use this right, you only have 63 days from dis-enrollment to enroll in a Supplement with Guarantee Issue Rights.

Trial Rights For Dropping Medicare Supplements

Those that switch from Medigap to Medicare Advantage and now want to change back can. Federal law allows you to buy your previous policy if it’s available. When your old plan is no longer an option, you can buy Medigap from any insurer. You must apply for Medigap at least as early as 60 days before you lose coverage but not later than 63 days after coverage ends.

Your Medicare Advantage Plan is Leaving the Area or Leaving Medicare

When you lose coverage through no fault of your own, you have the right to switch to a Medigap plan rather than another Advantage plan. As early as 60 calendar days before the policy ends, you can apply for new coverage, but, after 63 days, it’s too late. Medigap can’t start until Advantage ends.

Guarantee Issue Documents You Need When Losing Medicare Advantage

Part C plans can cover medical expenses and prescriptions. Advantage plans change annually, and some policies leave the service area. If the company you’re currently with is discontinuing coverage, you’ll want to have some documents ready for a smooth transition.

The documents you’ll need to qualify for a plan change include:

  • You must have a dis-enrollment letter from your insurance provider
  • The date the coverage ends
  • The applicant name must be on the documentation

Is your Advantage plan subject to termination through no fault of your own? Well, if so, you’re eligible for Guaranteed Issue Rights! Now that you qualify, you can select a Medigap policy and avoid the health questions, guaranteeing coverage.

Moving Out of the Plan’s Service Area

A Medigap Select or Advantage plan only operates in one service area. When you leave your county, you qualify for Guaranteed Issue Rights. Having coverage in the place you live is essential. Notify Medicare of your move as soon as possible.

Just like when the plan leaves the service area, you have 63 days to get coverage before it’s too late.

An 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 after:

  • The date coverage ends
  • The notification of coverage was concluding
  • Or the time on a claim denial

Those that have COBRA can either wait until COBRA ends or buy a Medigap plan right away.

Guaranteed Issue Medicare Documents for Involuntary Coverage Loss

If you’re involuntarily losing group coverage, this means your plan is dropping you through no fault of your own. Involuntary means you didn’t cancel the coverage, and you’re not losing coverage for non-payment.

If you’re losing group coverage involuntarily, then you may qualify for Guaranteed Issue Supplemental insurance.

Applying for new coverage requires some documentation:

  • You must have the date that the coverage ends
  • You must have the applicant named on the documentation
  • Documentation must be on your employer or carrier letterhead

Sending your new insurer these documents is essential. They will issue you the health insurance you apply for with no worries about health.

Guaranteed Issue Medicare Documents for Voluntary Coverage Loss

If you’re voluntarily losing group coverage, then they aren’t leaving your area, but you are choosing to leave them. When you voluntarily lose coverage, there are times you can be eligible for Guaranteed Issue Rights.

When you talk to an agent, you should be ready to send this information to the insurance company:

  • You must have the date that the coverage ends
  • You must have the applicant named on the documentation
  • Documentation must be on your employer or carrier letterhead
  • You must indicate if coverage is primary or secondary

If you’re losing employer group coverage, you should speak with an expert about your options.

Losing Your Medigap Coverage Through No Fault of Your Own

When you lose coverage due to non-payment, the company considers that your fault. But, if your company goes bankrupt, that’s not your fault. In cases where the Medicare Supplement coverage is ending through no fault of our own, Guaranteed Issue Rights will apply.

A Medicare Company Didn’t Follow the Rules

If a company misleads you or doesn’t follow the rules, you may qualify for Guaranteed Issue Rights for a new policy. You may need to file a complaint with Medicare.

Medicare Supplement Guaranteed Issue State Policies

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.

Some rules are state-specific. For the lucky residents of Connecticut, New York, and Washington, Medigap is a Guaranteed Issue all 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.

The documents you’ll need for a supplement to supplement policy are these:

  • 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 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 a 30-days to change plans. The rule allows a switch to another Medigap plan with the same or lesser benefits, without medical underwriting. States with annual guarantee Issue periods still require documents to change.

The documents you’ll want to have handy include:

  • 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 name

Medigap Guaranteed Issue States: Policy Anniversary Rule

In Missouri, the Anniversary Guaranteed Issue Period allows anyone with a Supplement plan to get a 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 your 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 don’t 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 go to apply for new coverage, you want to have these documents ready:

  • Medicaid termination letter, which must state termination reasoning.
  • You must have the date that the coverage ends/ended.
  • You must have an applicant’s name on the documentation.

Which Medicare Supplement Plans are Guaranteed Issue?

The plans you’re eligible to use Guaranteed Issue Rights depend on the date your eligibility began.

How to Get Help Understanding Guaranteed Issue Rights

There are many reasons you qualify for Guaranteed Issue 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!

Enter Zipcode

Enter your zip code to pull plan options available in your area.

Compare Plans

Select which Medicare plans you would like to compare in your area.

Get Quote

Compare rates side by side with plans & carriers available in your area.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

12 thoughts on “7 Guaranteed Issue Rights with Medicare

  1. 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.

  2. 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.

  3. 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!

  4. 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.

    1. 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!

  5. 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?

    1. 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!

  6. 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?


Your email address will not be published. Required fields are marked *