All Medicare beneficiaries have certain periods during which their rights to purchase a Medicare supplement are protected. These are called your Medicare Supplement Guaranteed Issue (GI) Rights.
These rights are different from your one-time Medicare supplement open enrollment period, during which you can purchase any Medicare supplement without underwriting
So, what are guaranteed issue rights for? Well, these rights exist for situations outside of your Medigap open enrollment period. In these situations, you will have the right to buy certain Medicare supplement plans, outside of your 6-month open enrollment period without:
- Having to answer health questions
- Worrying about pre-existing condition exclusions or waiting periods
- Incurring any rate increase due to your personal health status
Medicare supplement guaranteed issue rights exist to protect you in specific situations. The most common one occurs you are working past age 65 for a large employer with more than 20 employees. When you leave that employer, you will have a guaranteed issue right, in most cases, to purchase a Medicare supplement without any underwriting, exclusions or rate surcharges. In this scenario, the guaranteed issue window last 6 months.
Other Common Guaranteed Issue Rights Situations
There are several other situations during which Medigap guaranteed issue windows are triggered. Some of these surround Medicare Advantage plans.
If you enroll in a Medicare Advantage plan right out of the gate at age 65, you have the right to change your mind for 12 months. If you do not like your Medicare Advantage plan for any reason, you can return to Original Medicare. When you do, you can purchase a Medicare supplement and the insurance company cannot turn you down.
You have a similar trial right if you try a Medicare Advantage plan sometime after you turn 65. If you have Original Medicare and a Medigap plan, and then you switch to a Medicare Advantage plan for the very first time, you have a trial right to change your mind for 12 months.
You can leave the Advantage plan and return to Original Medicare and re-enroll in the exact same Medigap plan you had before with the same insurance carrier. If the insurance company no longer sells that Medigap plan, you can choose a plan from another company.
This right occurs only once. Once you use that window, if you try a Medicare Advantage plan again in the future, you will not be given another trial right to leave it and get a Medigap plan without underwriting.
Moving or Plan Termination
Another common Medicare Advantage plan situation is when you move out of the plan’s service area. Since Medicare Advantage plans are specific to your residential area, you will lose that plan. You will then be given a guaranteed-issue right to purchase a Medicare supplement in your new area if you prefer that over choosing a new Medicare Advantage plan.
This same rule exists if you have Medicare SELECT policy and you move outside the network. The Medicare Supplement guaranteed-issue guidelines allow you to choose a new plan without underwriting.
Likewise, if a Medicare Advantage plan folds or terminates coverage in your service area, you lose your coverage through no fault of your own, this is another situation in which you would be given a GI window. For other scenarios in which GI exists, visit this page on Medicare’s website.
When using a GI-window, you can only buy certain Medigap plans. These are Medigap plans A, B, C*, D, G, F*, K, or L. You cannot buy Medigap plans M or N.
When using a guaranteed-issue window to join a Medigap plan after losing other coverage, you have up to 63 days from the date that coverage ends to elect a new plan under GI rules.
It’s also important to note that Medicare supplement guaranteed issue rules vary from state to state. In some states, you must have lost that other coverage involuntarily in order to qualify for a GI window.
Guaranteed Issue States
Some states have laws that go beyond the federal laws for guaranteed issue. Here’s a run-down of those states and their rules:
- In California and Oregon, there is a birthday rule. During the 30 days after your birthday each year, you can switch from a Medigap plan to another plan of equal or lesser benefits without underwriting. Switching Medicare supplement plans allows residents here to continually stay insured at the lowest possible premiums.
- In Washington, New York and Connecticut, Medigap policies are guaranteed issue year-round.
- In Missouri, you can change your policy once per year on its anniversary. This allows you to change to any other carrier offering the same Medigap plan for a lower price.
- In the state of Maine, you have the guaranteed right to change your policy to one of equal or lesser benefits IF you haven’t had any gaps in coverage longer than 90 days since you first enrolled in Medigap. Furthermore, insurance companies in Maine must offer Plan A to anyone that applies during a 30-day window each year.
Helpful Tips for your Medigap Guaranteed Issue Period
Since GI windows exist only for special circumstances in most other states, you need to keep any records that will help you provide you qualify. So, if your employer coverage ends, you should keep the creditable coverage letter from the prior insurance carrier. The insurance company will usually send this to you within 2 weeks of the last date of coverage.
If you left or lost a Medicare Advantage plan, keep the termination letter that you receive from the plan.
I’d also like to mention a few words about Plan G. People of ask us “Is Plan G guaranteed-issue?” it’s a reasonable question as Plan G is one of the top sellers. However, Plan G is not currently one of the plans you can choose under GI rules. If Plan G is the plan you really want, you should check to see if you can pass the health questions on the Medigap application.
If you are able to answer no to the Medicare supplement underwriting questions, there is a good chance you get approved for a Plan G. Go ahead and apply and see what happens. If you are declined, then you can still use your GI window to apply for one of the plans you CAN choose (Medigap plans A, B, C, F, K, or L). Be sure you apply before your 63-day window has expired.
Need help understanding Guaranteed Issue guidelines?
Our Medicare experts are very familiar with GI rules in all states. If you have a question about GI rules in your state, you can contact us for guidance.
The Boomer Benefits team has worked with just about every Medicare situation under the sun. If you are unsure of your next move with Medicare, the team will get to know your situation and recommend the best way forward. Contact us today!