Guaranteed issue rights are one of those Medicare terms that are important to be familiar with yet many people know so little about. That’s why we’d like to outline the specifics of guaranteed issue rights and help you to understand when they might apply to you.
What are guaranteed issue rights?
Guaranteed issue rights are special protections that you are granted in relation to enrolling in a Medigap policy. When you are granted a Medigap guaranteed issue right, an insurance company must sell you a policy regardless of your health conditions, past and present. The policy must also cover all of your pre-existing conditions, and you can’t be charged more for it because of any given health condition.
Medicare guaranteed issue rights are the only time outside of your Initial Enrollment Period (IEP) that you are granted these Medigap protections. It can be very important to understand your rights should you be interested in enrolling in or changing your Medicare Supplement plan.
When can you be granted guaranteed issue rights?
There are numerous situations in which Medicare supplement guaranteed issue rights apply. Some examples include moving out of your plan’s coverage area, if the plan that you are enrolled in leaves Medicare, or if your employer coverage is ending.
There are certain rights called trial rights that give you the option to try out a plan and change within your first year of enrolling. The first of these situations occurs if you join a Medicare Advantage or PACE (Programs of All-Inclusive Care for the Elderly) plan when you first become eligible for Medicare and want to switch back to Original Medicare.
If less than a year has passed since you enrolled and you decide to return to Original Medicare, you have the right to buy any Medigap plan offered by any insurance company in your state. This application period begins 60 calendar days before your coverage will end and extends for 63 days after your plan terminates.
Another trial right example occurs when you drop a Medigap policy to switch to Medicare Advantage or a Medicare SELECT plan for the first time. If you decide within a year of making that switch that you would like to return to your Medigap plan, you can do so.
If your former Medigap plan is no longer available, you can switch to Plan A, B, C*, D, F*, G, K or L with any insurance company in your state. You must do so within the time period that begins 60 calendar days before your coverage ends and extends 63 days after your plan terminates.
You Move Out of Your Plan’s Coverage Area/Your Plan Leaves Medicare
If you have a Medicare Advantage or SELECT plan and you move out of your plan’s coverage area, or alternatively your plan is leaving your area (or leaving Medicare altogether), you will be granted a guaranteed issue right if you return to Original Medicare.
You will be allowed to enroll in Medigap Plan A, B, C*, D, F*, G, K, or L with any insurance company in your state. This guaranteed issue right begins 60 calendar days before your coverage ends and extends 63 days after your plan terminates.
It is important to highlight that moving doesn’t trigger a guaranteed issue right if you are already enrolled in a Medigap plan. In this case, you can keep your current Medicare Supplement, though your monthly premium may change, especially if you are moving to a different state.
Your Employer Coverage Ends
If you have Original Medicare and employer coverage and your employer coverage is ending (this includes retiree, COBRA, and union coverage), you are granted a guaranteed issue right.
You can sign up for Medigap Plan A, B, C*, D, F*, G, K, or L with any insurance company in your state. You must apply for a Medicare Supplement plan within the 63 days following the latest of these dates:
- Date your coverage ends
- Date on the notice that informed you your coverage was ending (if you get one)
- Date on a claim denial, if this is how you found out that your coverage ended
In certain circumstances, your rights may extend for an additional 12 months. Finally, if you have COBRA coverage, you have the right to buy a Medigap policy right away or wait until your coverage ends.
Your Medigap Insurance Company Goes Bankrupt
In the case that your Medigap company goes bankrupt, you will be granted another opportunity to enroll in a Medicare Supplement. If this happens, or if your Medigap coverage ends through no fault of your own, you will have 63 days after your coverage ends to enroll in a new Medigap plan.
You can choose between any insurance company that sells Medicare Supplement Insurance in your state, and you have the option to sign up for Medigap Plan A, B, C*, D, F*, G, K, or L.
Your Insurance Company Mislead You or Didn’t Follow the Rules
This guaranteed issue right is granted in the case that you leave your Medicare Advantage plan or Medigap policy because the insurance company misled you or didn’t follow the rules. You will have 63 calendar days after your coverage ends to enroll in a new Medigap plan. You can choose between Medigap Plan A, B, C*, D, F*, G, K, or L, and you can enroll with any insurance company that operates in your state.
*Medigap Plan C and Plan F are no longer available to beneficiaries who became newly eligible for Medicare on or after January 1, 2020. These beneficiaries have the option to enroll in Plan D or Plan G instead of Plans C and F.
Guaranteed Issue Rights by State
Believe it or not, each state has its own unique guaranteed issue rights guidelines. So, depending on where you live, you may have more or less opportunities to be granted a guaranteed issue right than if you reside elsewhere.
In fact, there are 31 states that offer expanded guaranteed issue rights which go beyond the minimum federal standards. 28 states offer protection when involuntary changes are made to your employer’s plan, and 9 states grant you a guaranteed issue right should you lose your Medicaid eligibility.
Additionally, there are four states that offer continuous protection or an annual open enrollment period. Connecticut and New York have instated continuous open enrollment and guaranteed issue rights all year round. Massachusetts offers a Medigap open enrollment period from February 1-March 31 each year, and Maine requires insurance companies to issue Medigap Plan A (the most basic Medicare Supplement) during an annual one-month open enrollment period.
Alternatively, some states offer guaranteed issue rights for people who are already enrolled in a Medigap plan. California and Oregon allow beneficiaries to switch to a Medigap plan with equal or lesser benefits each year within the 30 days following their birthday. In Missouri, you are allowed to switch to an equivalent Medigap plan during the 30 days before and after the anniversary date of your policy.
As you can see, there are plenty of nuances to guaranteed issue rights that the average Medicare beneficiary may not be aware of. If you have doubts about how guaranteed issue rights may affect you, or you are simply seeking Medicare advice, feel free to reach out to us free of charge. One of our licensed insurance agents can answer all of your questions and guide you in your Medicare journey.