What are Guaranteed Issue Rights for Medigap?

What are Guaranteed Issue Rights for Medigap

Have you wondered why some people can bypass all those medical questions on Medigap applications, while others must answer them?  These seniors have what is called “guaranteed issue rights, also known as “Medigap protections”.  It is when insurance companies afford you the right, under certain circumstances, to enroll in Medigap policies without having to answer medical questions.  What are Guaranteed Issue Rights for Medigap
The insurance companies that sell Medigap plans are required by law during this protected time to:

  • sell you a Medigap policy at the best available rate regardless of your health condition. They cannot deny you coverage
  • cover all your pre-existing health conditions
  • NOT to charge you more for a Medigap policy because of any health problems, whether in the past or present.

Although insurance companies must follow the Federal law, each state may include additional enrollment periods during which Medigap protection rights may exist.  You need to check with your state SHIP (State Health Insurance Assistance Program) for more information.

In Which Situations Can You Use Guarantee Issue Rights for Medigap?

  1. If you currently have health coverage through an employer group plan (including retiree or COBRA) or through a union, and that coverage will be ending. Note: If you are on COBRA, you can enroll in a Medigap policy immediately or when your COBRA coverage is terminated.

To have your guaranteed issue right applied:

  • It must be no later than 63 calendar days from the date you lose your coverage; or
  • You get a notice telling you that your coverage is ending; or
  • You have proof of that date on a claim denial, if none of the other two options are available.
  • Please note, that your guaranteed issue rights may be extended for up to 12 months in certain situations depending on State law.

Make sure you keep a copy of any letters, notices, postmarked envelopes, and claim denials, as you may need to show proof and include them with your Medigap application. 

  1. If you were enrolled in Medicare Part C (Medicare Advantage Plan) when you were first eligible for Medicare, or PACE (Programs of All-inclusive Care for the Elderly) and disenrolled within the first 12 months you had the plan to return to Original Medicare (Trial Right). Know the differences in Medigap and Medicare Advantage
  • The earliest date you must/can enroll in a Medigap policy is two months prior to the date your coverage will end; but no later than 63 calendar days following the termination of your coverage. 
  1. You are in a Medicare Advantage Plan, and your plan is leaving Medicare or can no longer provide care in your area, or you are moving out of your Medicare Advantage plan’s service area.
  • The earliest date you must/can enroll in a Medigap policy is two months prior to the date your coverage will end; but no later than 63 calendar days following the termination of your coverage.
  1. You have a Medicare Select policy and you move out of your plan’s service area.
  • The earliest date you must/can enroll in a Medigap policy is two months prior to the date your coverage will end; but no later than 63 calendar days following the termination of your coverage.
  1. You lose your coverage because of your Medigap insurance company going bankrupt, or your Medigap policy coverage ends through no fault of your own.
  • You must/can enroll not later than 63 calendar days from the date your coverage ends.
  1. You leave a Medicare Advantage Plan or are disenrolled from a Medigap policy due to the insurance company ignoring the rules, or misleading you.
  • You have 63 calendar days from the date your coverage ended to buy a Medigap policy under guaranteed issue rights. 

Note that you can enroll in a Medigap plan at any time. There is not an annual enrollment period for these plans. However, if you are not in one of these “guaranteed issue” situations, you have to answer medical questions and “qualify” in most situations. Regardless of your situation, it is important to follow the steps to compare Medicare Supplement plans before enrolling.
Lastly, it is strongly advisable to enroll in a Medigap policy before your current health care coverage ends.  You can apply while you still have your coverage but the earliest effective date won’t be until the day after your current coverage ends.  At all cost, try not to have any breaks in health care coverage, otherwise, you may not be eligible for Medigap protection when you most need it!

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About the Author

Garrett Ball

Garrett is the founder/President of Secure Medicare Solutions, a leading, independent Medicare insurance agency. Since 2007, Garrett has worked with tens of thousands of people turning 65 or already on Medicare to understand, compare and choose Medicare insurance that fits their specific needs and situation.

His latest project is 65Medicare.org, an online hub for people just starting with Medicare, which is focused on distilling difficult Medicare questions into easy-to-understand resources.

Garrett resides in North Carolina with his lovely wife, Celeste, and three spirited children.

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