Guaranteed Issue Rights for Medigap Plans
By Melissa A. Brown
Seniors often wonder when they are guaranteed to be approved for enrollment in any Medicare supplement plan of their choice without the threat of being denied for medical reasons. This right, called “guaranteed issue,” helps determine the access and affordability of Medigap plans for Medicare beneficiaries.
Initially, you are entitled to guaranteed issue during your open enrollment for Medigap. Your Medigap open enrollment begins when you meet the dual requirements of reaching age 65 and enrolling in Medicare Part B, and it lasts for a period of six months from the first day of the month in which you meet these requirements.
If you join a Medicare Advantage plan or a Program of All-Inclusive Care for the Elderly (PACE) plan at age 65, you may switch to original Medicare within your first year. If you do switch, you are entitled to enroll for a Medicare supplement plan under guaranteed issue status. This is called a “trial right” because it allows you to try these other programs without incurring any penalty toward a Medigap policy.
Similarly, if you purchase a Medigap plan, but then cancel this policy to pick up Medicare Advantage or Medicare Select plan for the first time, you can switch back to Medigap within the first year.
Under both of these trial right scenarios, the rules grant you eligibility for the guaranteed issue of a Medigap plan if you apply up to 60 days before but no more than 63 days after your current coverage ends.
Medicare Advantage Scenarios
If you join a Medicare Advantage plan and that plan ceases to offer services in your area, you move to an area where the plan does not provide coverage or the plan leaves Medicare, you are entitled to the guaranteed issue of Medicare supplements. Like the trial right rules, application is time-sensitive and must be completed up to 60 days before or 63 days after the end of your Medicare Advantage coverage.
If you quit a Medicare Advantage plan or drop a Medicare supplement plan because your private insurer misled you or violated the law, you may qualify for a guaranteed issue Medigap plan if you apply within 63 days the last date of coverage.
If you have original Medicare and another group health plan (such as employer, COBRA or retiree coverage) and the second plan ends, you are eligible for Medicare supplements on a guaranteed issue basis. You should apply for a supplement policy within 63 calendars days after the group plan ends.
Seniors with original Medicare and a Medicare Select policy who move out of the area of the Select policy may choose to keep their supplement policy or switch to another Medigap plan. If you switch, your application must be submitted up to 60 days before, but no less than 63 days after, the end date of the coverage.
If you lose your Medicare supplement policy or it is cancelled due to bankruptcy or other circumstances beyond your control, you may qualify for guaranteed issue if you apply no more than 63 calendar days after your last day of coverage.
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