Medicare Supplement (Medigap) Guaranteed Issue Rights

I have a guaranteed issue right.

Guaranteed issue rights (also called "Medigap protections") are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:

• Must sell you a Medigap policy
• Must cover all your pre-existing health conditions
• Can't charge you more for a Medigap policy because of past or present health problems

In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a "trial right" to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change your mind.

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

• You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.

You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.

You can/must apply for a Medigap policy:

• As early as 60 days before the date your coverage will end
• No later than 63 calendar days after your coverage ends 

Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.

• You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.

If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.

You can/must apply for a Medigap policy no later than 63 calendar days after the latest of these 3 dates:

• Date the coverage ends
• Date on the notice you get telling you that coverage is ending (if you get one)
• Date on a claim denial, if this is the only way you know that your coverage ended

Note

Your rights may last for an extra 12 months under certain circumstances.

• You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy's service area.

You can/must apply for a Medigap policy:

• As early as 60 calendar days before the date your coverage will end
• No later than 63 calendar days after your coverage ends

Call the Medicare SELECT insurer for more information about your options. Find the phone number for the Medicare SELECT company.

• You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)

You have the right to buy any Medigap policy that’s sold by any insurance company in your state.

You can/must apply for a Medigap policy:

• As early as 60 calendar days before the date your coverage will end
• No later than 63 calendar days after your coverage ends

Note

Your rights may last for an extra 12 months under certain circumstances.

• You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)

You have the right to buy:

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it.

You can/must apply for a Medigap policy:

• As early as 60 calendar days before the date your coverage will end
• No later than 63 calendar days after your coverage ends

Note

Your rights may last for an extra 12 months under certain circumstances.

• Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You can/must apply for a Medigap policy no later than 63 calendar days from the date your coverage ends.

• You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you.

You can/must apply for a Medigap policy no later than 63 calendar days from the date your coverage ends.

Note

There may be times when more than one of the situations above applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice.

Can I buy a Medigap policy if I lose my health care coverage?

You may have a guaranteed issue right to buy a Medigap policy. Make sure you keep these items:

• A copy of any letters, notices, emails, and/or claim denials that have your name on them as proof of your coverage being terminated
• The postmarked envelope these papers come in as proof of when it was mailed

You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right.

If you have a Medicare Advantage Plan but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the plan. Ask that the new policy take effect no later than when your Medicare Advantage enrollment ends, so you’ll have continuous coverage.

Note

The guaranteed issue rights in this section are from Federal law. These rights are for both Medigap and Medicare SELECT policies. Many states provide additional Medigap rights.

If you have group health insurance through an employer or union, your Medigap open enrollment period will start when you sign up for Part B.

• The insurance company can't make you wait for your coverage to start, but it may be able to make you wait for coverage if you have a pre-existing condition.
• In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months (called the "pre-existing condition waiting period"). After these 6 months, the Medigap policy will cover your pre-existing condition.
• Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.
• When you get Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs, but you're responsible for the coinsurance or copayment.
• Get more information on the Pre-Existing Condition Insurance Plan.

It's possible to avoid or shorten waiting periods for a  pre-existing condition if you buy a Medigap policy during your Medigap open enrollment period to replace "Creditable coverage (Medigap)."

If you have had at least 6 months of continuous prior creditable coverage, the Medigap insurance company can't make you wait before it covers your pre-existing condition. Many types of health care coverage can count as creditable coverage for Medigap policies, but they’ll only count if your break in coverage was no more than 63 days.

Receive more information on the Pre-Existing Condition Insurance Plan.

By contacting the phone number on this website you will be directed to a licensed insurance agent.

Source: www.medicare.gov