Medigap Guaranteed Issue Rights

If you enrolled in Original Medicare (Part A and Part B) and you are interested in supplementing your coverage with a Medicare Supplement (Medigap) plan, it is important to apply during Medigap Open Enrollment (within 6 months from the time you activate your Part B with Medicare) or when you have Medicare Supplement Guaranteed Issue Rights. These rights give you the best opportunity to buy the plan you want at the most affordable price.

What are Medicare Supplement Guaranteed Issue Rights?

Medicare Supplement (Medigap) plans are sold by private insurance companies approved by Medicare. Although plan benefits are determined and “standardized” by the federal government, private insurers generally have the final say about who they will cover and at what price—unless you have a Medicare Supplement Guaranteed Issue Right.

When you have Medicare Supplement Guaranteed Issue Rights, the insurance company must sell you any Medicare Supplement (Medigap) plan sold in your state, regardless of your health history. The insurer must also cover your pre-existing conditions. Finally, the company cannot increase your premiums if you have a serious health condition; they generally must sell you the plan at the same premium they charge anyone else. If you plan to buy a Medicare Supplement (Medigap) plan available in your state, you should generally do so when you have Guaranteed Issue Rights.

Can I buy Medicare Supplement Plans without Guaranteed Issue Rights?

It’s hard to say whether or not a company will sell you a plan without Medigap Open Enrollment or Guaranteed Issue Rights. Most companies will make you pass medical underwriting before offering you a plan. During medical underwriting, the insurer can look at your past medical history and prescription medications. If you have serious or chronic health conditions such as diabetes, heart disease, or COPD, they may deny your application for a Medigap plan. Depending on your health history, they may offer you a different plan with less comprehensive coverage (Perhaps a Plan A instead of Plan G), and they could impose a 6-month waiting period on pre-existing conditions. They could offer to sell you a plan but at a higher premium than a healthier person would pay.

When do I have Medicare Supplement Guaranteed Issue Rights?

The Open Enrollment period for Medicare Supplements (Medigap) starts when you are age 65 or older AND enrolled in Part B. This period lasts for 6 months.

Outside of this Medigap Open Enrollment period, you may have Guaranteed Issue Rights for a short period of time related to certain special situations. For example: If you have Medicare Advantage, and your plan is no longer operating in your area, or you move out of your plan’s service area, you have a window of time with Guaranteed Issue Rights to buy Medicare Supplement Plans. If you joined Medicare Advantage when you first became eligible for Medicare, but decided to switch to Original Medicare within the first 12 months, you have Medicare Supplement Guaranteed Issue Rights for 60 days before your plan ends and 63 days after you switch. If you dropped a Medigap plan to enroll in Medicare Advantage, but decide within 12 months to switch back (known as “trial right”), you have Medicare Supplement Guaranteed Issue Rights for the same four-month period described above.

If you joined a Medicare Advantage plan or bought a Medicare Supplement Plan, but the plan doesn’t follow Medicare rules or behaved unethically, you may also have short-term Guaranteed Issue Rights. Your window for Medicare Supplement Guaranteed Issue Rights may vary depending on the situation; be sure to check the timeframe for your specific circumstance. Also, in some cases, you may be limited to just a few Medicare Supplement Plans. In other words, in certain situations where you have Medicare Supplement Guaranteed Issue Rights, it may not apply to all available plans.

For more information on Guaranteed Issue Rights, please click HERE.

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