Medicare Supplement (Medigap) Guaranteed Issue Rights

August 7, 2019

When your 65th birthday nears, it’s time to consider your two choices in health care coverage: Enrolling in Medicare, with the addition of a Medicare supplement plan (also called Medigap), or enrolling in Medicare Advantage, which is Part A and B together with other options. The period for a decision only lasts six months, starting from the first day of your birthday month, so it’s the easiest and most appropriate time to enroll in a Medicare supplement plan policy if that’s your choice.

During that six-month Medicare supplement plan open enrollment period right after your birthday, you can choose from any of the Medicare supplement plan policies offered in your state, regardless of your health condition. You cannot be turned down or forced to pay extra because of the Medicare supplement plan Guaranteed Issue Rights afforded to everyone during his or her initial six-month period.

medigap

Source: Getty

Medicare supplement plans pay the costs that Part A and Part B don’t, including deductibles, coinsurance, copayments and out-of-country emergency coverage. After that six-month open enrollment time period, you run into problems with being turned away and facing more expensive policies when you apply. This is why you should take the choices offered to you during your initial enrollment period seriously – it is vital to your future coverage as well as your emotional well-being.

Regardless of which direction you take, Medicare plus supplement or Medicare Advantage, it’s important to know what to do if you change your mind afterward or if your circumstances now differ from that of your original signup date.

How do Guaranteed Issue Rights Benefit You?

Guaranteed Issue Rights for Medicare supplement plans are rights you have in certain situations where insurance companies have to offer you Medigap policies. It may mean you can choose your Medicare supplement plan policy without worrying about your current health issues during the six-month open enrollment period after your 65th birthday, but it’s not the only time you can enroll in a Medicare supplement plan policy. If you chose a Medicare supplement policy that now doesn’t work for you due to your relocation or due to changes within the policy itself (such as the policy no longer contracting with Medicare), you have guaranteed issue rights due you.

guaranteed issue rights

Source: Lifelong Insurance Agency

Your Medicare supplement plan guaranteed issue rights come into effect in the following situations:

  • You have original Medicare (Part A and B) as your primary payer, and your group health plan, including COBRA or retiree plan, is ending. You can choose Medicare supplement plan Plan A, B, C, F, K or L, but you must switch back to original Medicare to qualify and you cannot buy a Medicare supplement plan policy if you join another Medicare Advantage plan.

  • Your Medicare Advantage plan loses its Medicare contract, is discontinued in your area, or you move away from the plan’s service area.

  • You have original Medicare as well as a Medicare SELECT policy and you move out of the SELECT’s service area.

  • You have a Medicare supplement plan policy and your coverage ends through no fault of your own or your insurance company becomes bankrupt.

  • You leave your Medicare Advantage plan or cancel your Medicare supplement plan policy because the company misled you or committed fraud.

Keep in mind, the states of Massachusetts, Minnesota and Wisconsin have versions of Medicare supplement insurance plans for purchase, and residents of those states should contact their state insurance office to ensure they understand their choices and the rules that they must abide by for premium coverage.

You may even find that more than one of these situations applies to you, and if so, you must choose the Medicare supplement plan Guaranteed Issue Rights selection that gives you the best benefit at the best cost.

Let’s say you’ve continued working after you’ve turned 65 and your company policy covers you to your satisfaction. You may choose to delay enrolling in your Part B (the “medical coverage” part of Medicare) until right before your employer’s group coverage ends. In this case, your six-month enrollment time period will begin. Buy your Part B plan before your coverage at work ends; if you wait, you may have to pay a penalty.

guaranteed issue rights

Source: United Medicare Advisors

Also keep in mind that though you enroll and are accepted into a Medicare supplement plan policy coverage, some companies require a “pre-existing condition waiting period,” usually six months, where only Medicare will cover your situation’s costs, but you’d still be responsible for copays and other costs usually covered under a Medicare supplement plan policy.

It pays to research – carefully – and speak with others about all the options open to you. However, as long as you’ve maintained your group coverage, you are assured a 63-day guaranteed issue window where you can enroll in Medicare supplement plan A, B, C, F, K or L with no worry about pre-existing conditions. Note, however, that Plan G is not under this guarantee.

Guaranteed Issue Trial

You may also qualify for using what’s called a Medicare supplement plan Guaranteed Issue Trial if you joined a Medicare Advantage plan when you were first eligible and you now want to switch back to original Medicare. This option is available as long as you are still within your first year of eligibility. Here’s how you qualify for guaranteed issue trial rights:

  • Within the first year of joining a Medicare Advantage plan, you want to switch back to original Medicare.

  • You got rid of your Medigap policy to get a Medicare SELECT policy or join a Medicare Advantage plan for the first time and want to switch back to a Medigap plan. You can switch back to the same Medigap plan you had before.

How to prove you have Medigap Guaranteed Issue Rights

Send a copy of the following documents with your Medigap application:

  • Letters, emails, notices and claim denials with your name on them that prove your coverage is being terminated.

  • The envelopes these documents come in can prove when they were mailed to you buy their postmarked dates.

Bottom Line

Medicare supplement plan Guaranteed Issue Rights are protections that give you the right to enroll in any Medicare supplement plan offered by any insurance company in your state, regardless of your health status. If you qualify for one of the rights mentioned, the insurance company must cover all of your pre-existing conditions (though you might have to wait up to six months). It also cannot require medical underwriting for your coverage, cannot deny you coverage and cannot charge you more due to health reasons (unless the company specifically says it charges more for particular situations, which should alert you this policy is not a good choice for you.)