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Medicare Supplement (Medigap) Guaranteed Issue Rights

Mike Olmos by Mike Olmos | Licensed since 2010
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This article was updated on: 02/27/2016

When you apply for a Medigap policy (Medicare Supplement insurance), you have certain rights, which, by federal law, can protect you from being denied coverage. If you already have a policy, you also have rights to protect you from having to keep a plan that is not right for you. These rights are called Medigap protections, or guaranteed issue rights.

Medigap guaranteed issue rights
During your six-month Medigap Open Enrollment Period, you have the right to buy any Medigap policy offered in your state. Although this is the best time to purchase a Medigap policy, there are also a few situations outside the open enrollment period when you may still have a guaranteed right to buy a Medigap policy if you’re 65 or older.

In general, you qualify for a guaranteed issue right when you have other health-care coverage that changes in some way, such as if you lose the coverage for any reason that is not your fault. In these situations, an insurance company must sell you a Medigap policy and cover all your pre-existing health conditions. The company cannot charge you more for a Medigap policy despite past or current health problems.

You qualify for Medigap guaranteed issue rights under the following situations:

Your situation What plans you can buy
You’re in a Medicare Advantage plan, and:

  • Your plan loses its contract with Medicare, or
  • Your plan is discontinued in your service area, or
  • You move out of the plan’s service area.
Medigap Plan A, B, C, F, K, or L

  • You must switch back to Original Medicare to qualify for this right.
  • You cannot buy a Medigap policy if you join another Medicare Advantage Plan.
You have Original Medicare (Part A and Part B) and a group health plan (including retiree or COBRA coverage), and:

  • Medicare is your primary payer, and
  • Your group coverage is ending.
Medigap Plan A, B, C, F, K, or L

  • You do not have to wait for your COBRA coverage to end before getting a Medigap policy.
You have Original Medicare and a Medicare SELECT policy, and:

  • You move out of the Medicare SELECT policy’s service area.
Medigap Plan A, B, C, F, K, or L

  • Ask your Medicare SELECT insurer about any other options.
You have a Medigap policy, and:

  • Your insurance company goes bankrupt and you lose your coverage, or
  • Your coverage ends for reasons that are not your fault.
Medigap Plan A, B, C, F, K, or L
You leave your Medicare Advantage plan or cancel your Medigap policy because:

  • The company committed fraud, or
  • The company misled you.
Medigap Plan A, B, C, F, K, or L

Residents of Massachusetts, Minnesota, or Wisconsin should take note that their states have their own versions of Medicare Supplement insurance. For more information on Medicare Supplement insurance in these states, contact your state insurance department directly.

Guaranteed issue trial rights
Another type of right is called a trial right, which lets you buy or switch back to a Medigap policy within the first year of either joining a Medicare Advantage plan or buying a Medicare SELECT policy.

You qualify for guaranteed issue trial rights under the following situations:

Your situation What plans you can buy
You joined a Medicare Advantage plan when you were first eligible for Medicare Part A at 65, and:

  • Within the first year of joining, you want to switch back to Original Medicare.
Any Medigap plan sold in your state
You dropped a Medigap policy to buy a Medicare SELECT policy or to join a Medicare Advantage plan for the first time, and:

  • You have been in the plan less than a year, and,
  • You want to switch back to Medigap.
The same Medigap policy you had before you joined the Medicare Advantage plan or Medicare SELECT policy

  • If your former insurance company does not offer this policy anymore, you can buy any Medigap Plan A, B, C, F, K, or L sold in your state.

How to prove you have Medigap guaranteed issue rights
To prove you have a guaranteed issue right, you may need to send a copy of the following documents with your Medigap application:

    • Any letters, notices, emails, and/or claim denials that have your name on them to prove that your coverage is being terminated
    • The postmarked envelope these papers come in to prove when they were mailed to you

Keep in mind that certain states may have additional consumer protections and rights over and above federal law, so check with your state insurance department for details.

Think a Medicare Supplement plan could be a good idea for you? I can help you figure that out. My profile, which you can see using the “View profile” link below, will give you a pretty good sense of who I am. Use the links below to set up a time to speak with me on the phone. I can also email you information ahead of time to get you started. If you’d like to explore on your own for now, click on the Compare Plans buttons on this page; it will help you see the Medigap plans available to you. Have a question that needs to be answered in person? Call Medicare.com’s licensed insurance agents at 1-844-847-2659, TTY users 711; Monday through Friday, 8AM to 8PM ET.

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