What are Medicare Supplement Guaranteed-Issue Rights?
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What are Guaranteed-Issue Rights?
Guaranteed-issue rights may protect you from medical underwriting. Health insurance companies often use your health history and data on pre-existing conditions to make determinations about whether or not they will cover you and how much they will charge you for coverage. This process is called medical underwriting. There are two situations where you won’t be subjected to medical underwriting when applying for a Medicare Supplement plan. The first situation is during your Open Enrollment Period (OEP), which lasts for six months and starts when you are both 65 or older and enrolled in Medicare Part B. The second situation is if you have guaranteed-issue rights. Guaranteed-issue rights usually occur when you are exercising a trial right or because you lose health insurance through a situation outside of your control or because you move.
How can I get guaranteed-issue rights?
Specific situations in which you usually have guaranteed-issue rights are described below. Some states may allow additional situations to qualify you for guaranteed-issue rights. Outside of your Medicare Supplement OEP, guaranteed -issue rights are often limited to six Medicare Supplement plans: A, B, C, F, K, or L. This excludes the four additional plans, D, G M, and N, which are offered by most states during your Medicare Supplement Open Enrollment Period.
Situation 1: You have a Medicare Advantage plan.
What happens: Your Medicare Advantage plan leaves Medicare or stops giving care in your area, or you move out of the plan’s service area.
What you can do with guaranteed issue: As early as 60 calendar days before your coverage ends but not more than 63 days after your coverage ends, you can apply for a Medicare Supplement policy if you decide to switch to Original Medicare rather than enrolling in another Medicare Advantage plan. Your Medicare Supplement coverage won’t begin until your Medicare Advantage coverage ends.
Situation 2: You have Original Medicare (Part A and Part B) combined with an employer group health plan or union coverage that pays after Medicare pays its share of covered costs.
What happens: Your employer group health plan, including retiree, COBRA, or union coverage is ending.
What you can do with guaranteed issue: You can sign up for the six limited Medicare Supplement policies available to you (A, B, C, F, K or L) no later than 63 days after any of these:
- Your coverage ends
- Your notice is dated telling you that your coverage is ending
- The date on your claim denial (if this the only way you know your coverage is ended)
If you have COBRA coverage, you can either buy a Medicare Supplement policy right away or wait until the COBRA coverage ends.
Situation 3: You have Original Medicare and a Medicare SELECT policy. (Medicare SELECT is a type of Medicare Supplement that may require you to use hospitals and doctors in-network in order to be fully eligible for benefits)
What happens: You move out of the Medicare SELECT policy’s service area.
What you can do with guaranteed issue: As early as 60 calendar days before the date your Medicare SELECT coverage will end but not more than 63 calendar days after you Medicare SELECT coverage ends, you can apply for any Medigap Plan A, B, C, F, K or L that’s sold in your state or the state you’re moving to.
Situation 4: You are in a trial right of Medicare Advantage, meaning that you joined a Medicare Advantage plan when you were first eligible for Medicare Part A at age 65 but you changed your mind.
What happens: Within 12 months of joining Medicare Advantage you decide you want to switch to Original Medicare.
What you can do with guaranteed issue: As early as 60 calendar days before the date your coverage will end but no later than 63 days after your coverage ends, you have the right to buy any Medicare Supplement policy that is sold in your state by any insurance company.
Situation 5: You dropped a Medicare Supplement plan to join a Medicare Advantage plan or you switch to a Medicare SELECT policy (another example of a trial right).
What happens: In less than a year, you decide you want to switch back to your Medicare Supplement plan.
What you can do with guaranteed issue: As early as 60 calendar days before your coverage will end but no later than 63 calendar days after your coverage ends, you can buy the same Medicare Supplement policy you had before you joined Medicare Advantage or Medicare SELECT policy (if the company you had before still sells it). If your former policy is no longer available, you can buy any Medigap Plan A, B, C, F, K or L that’s sold in your state.
Situation 6: You lose your Medicare Supplement policy.
What happens: Your Medicare Supplement goes bankrupt and you lose coverage through no fault of your own, or your Medicare Supplement company hasn’t followed the rules or misled you.
What you can do with guaranteed issue: No later than 63 calendar days from the date your coverage ends, you can buy a Medigap plan A, B, C, F, K or L.
Keep in mind that this is not an exhaustive list of situations that could qualify you for guaranteed issue. Also keep in mind that in most situations you must apply for your Medicare Supplement policy within 63 calendar days of your previous coverage ending. Calendar days include weekends, so don’t put off your application too long. When your guaranteed-issue period expires, then you may be subjected to medical underwriting when applying for a Medicare Supplement plan.
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