Guaranteed issue rights (also called Medigap protections) are rights that you have in specific situations when an insurance company must sell you a Medicare Supplement (Medigap) Plan and cover all your pre-existing health conditions. The insurance company will issue the policy with no underwriting due to special circumstances other than a person becoming eligible for Part B of Medicare. Below are situations in which you will have a guarantee issue. Guarantee issue plans are: A, B, C, D, F, G, K, or L.
- Initial Enrollment Period (IEP): Medicare offers those who are turning 65 a 7-month period of time to enroll called the Initial Enrollment Period. Initial Enrollment begins three months prior to your 65th birthday and ends three months after you turn 65. After you enroll in Original Medicare (Part A and Part B) and during your IEP, you can purchase a Medicare Supplement plan, a Medicare Advantage (Part C) plan or a Medicare prescription drug (Part D) plan. In most cases, this is a one-time only opportunity.
- Medicare Advantage trial right: If you purchased a Medicare Advantage plan when you were first eligible for Medicare Part A, within the first year of joining, you can decide to move back to Original Medicare and have a guarantee issue for a Medigap Plan that is sold in your state by any insurance company. This is your trial right. This trial right is for up to 12 months and could last an additional 12 months under specific circumstances. You can purchase your Medigap Plan up to 60 days before your coverage end date, but no later than 63 calendar days after your coverage ends.
- Medicare Advantage and you move: If you’re in a Medicare Advantage plan (such as an HMO or PPO) but move outside of its service area and you return to original Medicare instead of joining another Advantage plan. You must purchase your Medicare Supplement (Medigap) Plan no later than 63 days after the plan’s coverage ends.
- Your Medicare Advantage plan is no longer offered in your area: If you’re in a Medicare Advantage plan that withdraws service from your area or closes down, and you return to original Medicare. You must purchase your Medicare Supplement (Medigap) Plan no later than 63 days after the plan’s coverage ends.
- Employer Group Health Coverage ends – Referred to as having creditable coverage is ending: If you have any type of employer or union insurance that is secondary to Medicare including retiree health benefits and COBRA coverage, you may qualify for a guarantee issue. You can buy a Medicare Supplement (Medigap) policy no later than 63 days after the date the coverage ends or you find out that the coverage has ended.
- You are under 65 and you are entitled to Social Security Disability: Medicare is available to certain individuals who are under the age of 65 and receiving Social Security Disability. Unfortunately, many states charge up to four times more in premium for beneficiaries under age 65. You will get another guarantee issue right when you turn 65. If your state charges more in premium, remember a Medicare Advantage Plan can at least help you cover costs that Medicare doesn’t pay for.
- You dropped a Medicare Supplement (Medigap) plan to join Medicare Advantage: If you dropped your Medicare Supplement (Medigap) plan to join a Medicare Advantage plan, you can return to original Medicare and get your Medigap policy back on the same terms provided as long as this is your first Advantage plan and it is not over 12 months. Your first year in a Medicare Advantage plan counts as a trial period.
- Medicaid: If you recently lost your Medicaid eligibility, you do have a guaranteed issue right to get a Medicare Supplement (Medigap) plan. You will need proof that your coverage is being terminated and you only have 63 days to complete.
- Some State Laws: There are a few states that allow residents to buy Medicare Supplement (Medigap) plans with a guarantee issue at any time in any year or once a year during your birthday month.
- You lose your Medicare Supplement (Medigap) Plan through no fault of your own: Your Medicare Supplement Insurance company goes bankrupt or stops your coverage through no fault of your own. You must change plans no later than 63 calendar days from the date your coverage ends.
Please Note: With most guarantee issue rights, you have the right to Medigap Plan A, B, C, D, F, G, K, L that is sold in your state by any insurance company. Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. If you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.
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