Medigap Guaranteed Issue – Can You Qualify?

7 Ways to Qualify for Medigap Guaranteed issue

Medigap plans or Medicare Supplemental insurance plans are used to fill in the gaps to Original Medicare. You can enroll in a Medigap plan throughout the year.  There are situations where you may qualify for a Medicare Supplement policy without being declined for health reasons. Known as Guaranteed Issue Rights, this can be an optimal time to buy a Medigap Policy. Below are seven opportunities for Medigap Guaranteed Issue.

How To qualify for Medigap Guaranteed Issue Rights

1) Losing Medicare Advantage Plan

If you enrolled in a Medicare Advantage plan and your plan is no longer available in your area or you move where your plan is no longer accepted, you may qualify.

You can apply for a Medigap Plan as early as 60 calendar days before the date your health care coverage will expire, but not after 63 calendar days.  On the 64th day after your Medicare Advantage coverage ends, you will no longer be eligible for Guaranteed Issue.  You can still apply for a Medigap Plan, but will have to answer the application’s health questions.

2) Employer group coverage ends

If you have original Medicare and your coverage under a Group health plan through your employer is ending, you may qualify.

You have to apply for a Medigap Plan no later than 63 calendar days after the latest of these dates:

1. The date the health coverage expires.
2. The date on the notice you receive informing you that coverage is ending.
3. The date on a Claim denial (if this happens to be the only way you know coverage expired).

3)  You move out of coverage area

If you have a Medicare Select plan and are moving out of the coverage area, you may be eligible for Guaranteed Issue Rights.

You can apply for a Medigap plan as early as 60 days before the date your Medicare SELECT coverage expires, but not later than 63 days after your coverage ends. On the 64th day after your Medicare SELECT coverage ends, you will no longer be eligible for Guaranteed Issue.  You can still apply for a Medigap Plan, but will have to answer the application’s health questions.  On the 64th day, you may no longer be eligible for Guaranteed Issue.  You can still apply for a Medigap Plan,but will have to answer health questions on the insurance application.

4)  Trial Right for Medicare Advantage Plan or PACE

Those that joined a Medicare Advantage Plan (MAPD) or Programs of All-inclusive Care for the Elderly (PACE) when they were first eligible for Medicare Part A at age 65. You may switch back to Original Medicare within the first year of joining either plan (MAPD or (PACE).

Once you are back on original Medicare, you have the right to buy any Medigap policy sold in your state.  You may purchase a plan by any insurance company that offers Medicare Supplement insurance.  Like other Guaranteed Issue Right situations, you can apply as early as 60 calendar days before coverage expires, but not after 63 days. On the 64th day, you may no longer be eligible for Guaranteed Issue.  You can still apply for a Medigap Plan, but will have to answer health questions on the insurance application.

5)  Under Trial Right, you cancelled a Medigap Policy to join Medicare Advantage or SELECT

If you cancelled your Medigap Policy to join a Medicare Advantage Plan or Medicare SELECT plan for the first time (and you’ve been in the plan less than a year), you may be eligible for Guaranteed Issue Rights.

Important Notes about this Trial Right

You will get back the same Medigap policy you had before joining the Medicare Advantage or Medicare SELECT plan.  If the same insurance company you had no longer has this plan available, you can buy a Medigap Plan.  The plans that are available and sold in your state are A, B, C, F, K, or L. Your application must be submitted no later than 63 days from the date your coverage expired.    On the 64th day, you may no longer be eligible for Guaranteed Issue.  You can still apply for a Medigap Plan, but will have to answer health questions on the insurance application.

6)  Your Medigap Company stops providing service

If your Medigap insurance company is no longer available due to bankruptcy, going out of business, etc. you may be eligible for Guaranteed Issue Rights since the policy coverage ended through no fault of your own.

What can you buy?

Medigap Plan A, B, C, F, K or L are available if sold in your state by any insurance company.  Your application must be submitted no later than 63 days from the date your coverage expired.  On the 64th day, you may no longer be eligible for Guaranteed Issue. You can still apply for a Medigap Plan, but will have to answer health questions on the insurance application.

7) Your Medigap or Medicare Advantage company breaks the rules

If a Medigap or Medicare Advantage Plan company hasn’t followed rules set by Medicare, Guaranteed Issue Rights may be available to you.

What are your Medigap options?

Medigap Plan A, B, C, F, K or L are available if sold in your state by any insurance company. Your application must be submitted no later than 63 days from the date your coverage expired.    On the 64th day, you may no longer be eligible for Guaranteed Issue.  You can still apply for a Medigap Plan, but will have to answer health questions on the insurance application.

One more reason you might qualify for Medigap Guaranteed Issue.

If you live in California or Oregon, you have an additional opportunity for Guaranteed Issue. It’s called the Birthday Rule and applies if you already have Medigap Insurance.

To find out if you qualify for one of the seven opportunities for Medigap Guaranteed Issue, you can contact your state’s Department of Insurance or call us at 1-888-411-1329.

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