Aside from when you first enter Medicare, there’s no certainty that you’ll be able to enroll in a Medicare Supplement plan. Carriers can decline your application, or you may even be restricted from applying. Medicare Supplement guaranteed issue rights allow you to bypass some of the normal application procedures, and provide you with assured approval. There are two guidelines that Medigap guaranteed issue rights can help you work around:
- Timeframe: If you already have a Medigap plan, you can apply to switch to another one at any time of the year. However, if you have a Medicare Advantage plan, you can usually only change your coverage during the Annual Enrollment Period (October 15th – December 7th) and the Medicare Advantage Open Enrollment Period (January 1st – March 31st)
- Medical Underwriting: Medical underwriting is the process that carriers can use to determine if they’ll accept you based on your health. Some states never allow medical underwriting, but in those that do, you’ll be asked health questions as part of the application process.
There are several federally mandated Medicare Supplement guaranteed issue rights, and individual states can expand on them. These rights are crucial as they can help people who could otherwise be left without coverage. As long as you qualify and submit a completed application in the correct timeframe, carriers can’t deny your application.
How Do I Apply for a Guaranteed Issue Medicare Supplement Plan?
You can usually apply for a Medigap guaranteed issue plan the same way that you normally apply. You’ll have to note on the application that you’re using a guaranteed issue right, which one, and provide any requested supporting documentation. If you’re working with an agent, they’ll help you with this.
In order to receive a guaranteed issue Medicare Supplement plan, you’ll need to apply within a certain timeframe of your qualifying event. Your timeline can vary based on which right you’re using. In many cases, you can submit your application as early as 60 days ahead of time, which allows you to gather any documentation that you need and get your new coverage in place before your current insurance ends.
Am I Eligible for a Medicare Supplement Guaranteed Issue Right?
There are several situations in which you could use a federally mandated guaranteed issue right. In most cases, you’ll remain eligible for up to 63 days from the date your coverage ends.You may qualify if any of these circumstances apply to you.
- You’ve lost coverage through no fault of your own: If you’ve lost health coverage for a reason other than nonpayment, you could be eligible to use a guaranteed issue right for certain Medigap plans. For
instance:
- You have a Medicare Advantage plan, or a Medicare SELECT plan, and you move out of the carrier’s service area
- Your Medicare Advantage plan drops you from coverage or ceases operating in your area
- You have Medicare Part A and Part B as well as coverage through an employer, union, or COBRA that’s secondary to Medicare, and the plan is ending
- You’re 65, new to Medicare, and joined a Medicare Advantage plan or Programs of All-inclusive Care for the Elderly (PACE): This is also referred to as a Trial right, and you must be 65 to use it. If you started Medicare a few months into being 65, and you’re within a year of being on your plan, but you’re now 66, you’re no longer eligible. If you qualify, you can enroll in any Medigap plan.
- You had a Medicare Supplement plan, and left it for a Medicare SELECT policy or Medicare Advantage plan: If you’ve left your traditional Medigap policy for a SELECT plan or Advantage plan for the first time, and you’re within one year of being on it, you can use this Trial right. You’ll be able to return to your former policy with that carrier, but if it’s not available, you can select from specific Medigap plans.
- You have a Medicare Advantage plan or a Medicare Supplement plan, but the company either misled your or broke the rules: This may be the least used of the Federal guaranteed issue rights, as it can be hard to prove wrongdoing on the company’s part. If you do qualify, you’ll be able to pick from certain Medigap plans.
Does My State Have Special Medicare Supplement Guaranteed Issue Rights?
The following states have their own additional Medigap guaranteed issue rights.
- Birthday Rule: If you live in California or Oregon, you can enroll in a plan of equal or lesser value than your current Medigap plan each year around your birthday.
- Anniversary Rule: Missouri allows you to enter a plan of equal or lesser value than your existing Medigap plan around the anniversary date of your policy.
- Year-Round: Washington and Maine allow you to change an existing Medigap policy at any time without medical underwriting. New York and Connecticut never allow carriers to ask health questions, but if you have an Advantage plan, you’ll need to wait for an enrollment period. Details vary by state, so be sure to check the guidelines for details.
What are the Guaranteed Issue Medicare Supplement Plans?
Usually, when you use a Medigap guaranteed issue right, you won’t have access to all of the Medicare Supplement plans. If you’re applying for coverage under one of the Federal rights, you’ll have several options to choose from:
- Medigap Plan A
- Medigap Plan B
- Medigap Plan C *
- Medigap Plan F *
- Medigap Plan G *
- Medigap Plan K
- Medigap Plan L
* Only people who became eligible for Medicare before January 1st, 2020, will have access to Medigap Plan C and Medigap Plan F. Medigap Plan G is only available as a guaranteed issue plan to people who became eligible for Medicare on or after January 1st, 2020. You may still apply for Medigap Plan G through the usual methods (link to article) if you entered Medicare before 2020, but your acceptance may not be guaranteed.
Medicare Supplement guaranteed issue rights are incredibly valuable to people who may not be able to obtain a plan otherwise. If you think you qualify, you should begin the process as soon as possible, as it’s time-sensitive. Understanding the Medigap guaranteed issue guidelines can be confusing, so we’re here to help. If you need assistance determining your eligibility or how to apply, give us a call at (877)896-4612. One of our experts will be happy to provide you with guidance.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
Find Medicare Supplement plans in your area Find Medicare Supplement plans
Find Plans
Related Questions
-
How Do I Switch Medicare Supplement Plans?
-Mariah K.
-
What Is the Difference Between Medigap vs Medicare Advantage Plans?
-Ari C.
-
Can I Have a Medicare Supplement Plan with Pre-Existing Conditions?
-Ari C.