Buying a Medicare Supplement plan, also called Medigap, is often easiest during your one-time Medigap Open Enrollment Period. During that window, insurance companies generally cannot use your health history to turn you down or charge you more because of a medical condition.
But what happens if that window has already passed? In certain situations, you may have Medigap guaranteed issue rights. These rights can give you a chance to buy certain Medicare Supplement plans without medical underwriting.
Guaranteed issue rights can be very important, especially for people who are losing other coverage or leaving a Medicare Advantage plan under specific circumstances. The rules can be detailed, so it helps to understand the basics before making a coverage change.
What are Medigap guaranteed issue rights?
Guaranteed issue rights are federal protections that may require an insurance company to sell you a Medicare Supplement policy. When you qualify, the company generally cannot deny your application because of your health.
In many guaranteed issue situations, the company also cannot make you wait for coverage of a pre-existing condition. A pre-existing condition is a health problem you had before your new policy began.
These protections do not apply every time someone wants to change Medicare Supplement plans. They usually apply when you lose certain health coverage through no choice of your own, or when a Medicare Advantage plan changes in a way that affects you.
It is also important to know that guaranteed issue rules may limit which Medigap plans are available to you. You may not be able to choose every plan letter offered in your area.
When might you have guaranteed issue rights?
Several common situations may create a guaranteed issue right. The exact details can depend on where you live, the type of coverage you had, and when you apply.
- You leave a Medicare Advantage plan after moving. If you move outside your plan's service area, or your plan leaves Medicare or stops serving your area, you may have the right to buy a Medicare Supplement policy.
- You lose certain employer or union coverage. If you had Medicare along with a group health plan that provides coverage after Medicare pays, losing that group coverage may give you a protected chance to buy Medigap.
- Your Medicare Advantage plan ends. A plan may stop offering coverage in your area, end its Medicare contract, or otherwise leave the Medicare program. These events may trigger a guaranteed issue right.
- You joined Medicare Advantage for the first time and want to switch back. Some people try a Medicare Advantage plan when they first become eligible for Medicare. If they leave that plan within the first 12 months and return to Original Medicare, they may have a trial right to buy a Medicare Supplement plan.
- You dropped a Medigap policy to try Medicare Advantage. If you had a Medicare Supplement policy, joined Medicare Advantage for the first time, and switch back to Original Medicare within 12 months, you may have the right to get your prior Medigap plan back if it is still sold. If it is not available, another protected option may be available.
These are examples, not a complete list. Timing matters a great deal. In many cases, you have a limited time to apply after your other coverage ends or after you receive notice that it is ending.
Do guaranteed issue rights apply if I simply want a different Medigap plan?
Usually, no. If you already have a Medicare Supplement plan and simply want to change to another plan because you prefer different benefits or pricing, you may need to go through medical underwriting.
Medical underwriting means the insurance company can ask health questions and review your medical history. Depending on the carrier and your health, it may accept your application, charge a higher premium, or decline to offer coverage.
Some states provide extra consumer protections beyond federal rules. For example, certain states may offer annual plan-change opportunities or other guaranteed issue protections. Benefits, premiums, availability, and underwriting rules can vary by carrier and state.
Before canceling an existing Medicare Supplement policy, it is generally wise to make sure your new coverage has been approved and that you understand when it begins. Once you cancel a Medigap policy, getting another one later may not be as simple.
Which Medicare Supplement plans are available under guaranteed issue?
Federal rules generally require insurers to make certain standardized Medicare Supplement plans available to people with a guaranteed issue right. Depending on your circumstances, this may include Plan A, Plan B, Plan D, Plan G, Plan K, or Plan L.
If you became eligible for Medicare before January 1, 2020, you may also have access to Plan C or Plan F in some guaranteed issue situations. These plans are not available to people who first became eligible for Medicare on or after that date.
Plan G is often a popular option because it can cover many out-of-pocket costs left by Original Medicare after you meet the Part B deductible. Still, the best choice depends on your medical needs, budget, travel habits, and the plans available where you live.
A guaranteed issue right does not mean every company must offer every plan letter in every situation. It means you may have access to specific protected plan options under the applicable rules.
What proof do you need to use a guaranteed issue right?
When you apply, the insurance company may ask for documents showing why you qualify. Keep letters and notices related to your old coverage, Medicare Advantage plan, employer plan, or move.
Useful documents may include:
- A letter showing that your group health coverage is ending
- A notice that your Medicare Advantage plan is leaving your area or ending coverage
- Proof of your previous Medicare Supplement policy
- A copy of a plan disenrollment notice
- Documents showing the date you moved, if a move affected your plan service area
Keep copies of anything you send. If you are unsure whether a notice gives you a guaranteed issue right, do not assume you have plenty of time. Reviewing the situation early may help you avoid missing an application deadline.
How are guaranteed issue rights different from Medigap Open Enrollment?
Your Medigap Open Enrollment Period starts when you are 65 or older and enrolled in Medicare Part B. It lasts for six months. During that time, you can generally buy any Medigap policy sold in your state without health underwriting.
Guaranteed issue rights are different. They happen later because of a qualifying event, such as losing coverage or leaving a Medicare Advantage plan under a trial right. They are usually limited in time and may limit the Medigap plans you can buy.
Both protections can be valuable. However, neither one should be confused with the Medicare Annual Enrollment Period. That fall enrollment period lets people make certain Medicare Advantage and Part D drug plan changes, but it does not automatically create a right to buy a Medicare Supplement plan without underwriting.
Get help before making a coverage change
Changing Medicare coverage can affect your doctors, prescription drug coverage, and out-of-pocket costs. Medicare Supplement policies work with Original Medicare and do not include Part D prescription drug coverage, so you may need a separate Part D plan.
If you think you may have Medigap guaranteed issue rights, Eric can help you review your situation, understand your timeline, and compare available Medicare Supplement options. Reach out for free, no-pressure guidance before you make a coverage decision.