What Are Guaranteed-Issue Rights for the Medigap Open Enrollment Period?

Mike Olmos by Mike Olmos | Licensed since 2010
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This article was updated on: 09/16/2018

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If you’re new to Medicare, you may have heard that you can get a Medigap (Medicare Supplement) plan with “guaranteed issue” in some situations, such as during your Medigap Open Enrollment Period. Many people with Original Medicare decide to get Medigap coverage to help pay for certain out-of-pocket costs that Part A and Part B don’t cover, such as copayments, coinsurance, deductibles, or overseas emergency coverage.

If you have health problems that could make it difficult to get Medicare Supplement insurance, knowing the types of situations where you may have guaranteed-issue rights is especially important. Here’s an overview of how Medigap guaranteed-issue rights work and the times when you may have them.

What are Medigap guaranteed-issue rights?

Put simply, “guaranteed-issue rights” are Medigap protections that give you the right to enroll in any Medicare Supplement plan offered by any insurance company in your state, regardless of your health status.

If you have a guaranteed-issue right, the insurance company that sells the Medicare Supplement plan:

  • Must cover all of your pre-existing conditions; however, in some cases you might have to wait up to six months before those conditions are covered.
  • Cannot require medical underwriting.
  • Cannot charge you more for your policy because of health reasons.*
  • Cannot deny you coverage.

*Note that the insurance company may charge higher premiums for other reasons, depending on how it decides to price its Medigap premiums.

 Without guaranteed-issue protections, you might have more trouble getting the Medigap plan you want, especially if you have health problems. The insurance company may require medical underwriting and is allowed to take the results into consideration when deciding whether to issue you a policy. If you are able to find a Medigap plan, you might have to pay more for it. Or, you could be denied coverage altogether.

When can I buy a Medigap plan with guaranteed issue?

One of the best times to enroll in a Medigap plan with guaranteed issue is your Medicare Supplement Open Enrollment Period. This is the six-month period that starts automatically once you’re 65 or older and have Part B. Once your Medigap Open Enrollment Period has passed, it can’t be repeated, and you can’t get it again.

The Medigap Open Enrollment Period isn’t the only time you may have guaranteed-issue rights. You may be able to get a Medicare Supplement plan with guaranteed issue in certain situations (like if the insurance company that offers your plan goes bankrupt). However, the Medigap Open Enrollment Period is a great time to enroll in Medicare Supplement insurance because it’s a set, established time frame that gives you a legal right to any Medigap plan offered by any insurance company in your service area. After your Medigap Open Enrollment Period has passed, you’re not guaranteed this right unless you have a qualifying situation, and you might not be able to get a Medicare Supplement plan if you have pre-existing conditions.

Does everyone have guaranteed-issue rights during the Medigap Open Enrollment Period?

For most people, the Medigap Open Enrollment Period starts automatically if you have Medicare Part B and are 65 or older, and if you enroll in a plan during this period, you will generally be able to do so with guaranteed issue.

The rules are a little trickier if you’re under 65 with Medicare (for example, if you get Medicare because of a disability, end-stage renal disease, or amyotrophic lateral sclerosis). Insurance companies aren’t required by federal law to offer Medicare Supplement insurance to Medicare beneficiaries under 65. However, depending on where you live, you may be able to get a Medigap plan even if you’re not yet 65; some states require insurance companies to offer at least one type of Medicare Supplement plan to beneficiaries under 65. You can contact your state’s insurance department to find out how Medigap coverage works in your state, or visit Medicare.gov for a list of states where Medicare Supplement coverage may be available to beneficiaries under 65.

Can I get a Medigap plan with guaranteed issue during other times?

The Medicare Supplement Open Enrollment Period isn’t the only time that you might have guaranteed-issue rights. As mentioned, you may be able to get a Medigap plan with guaranteed issue in a few specific situations. Take a look at this article for examples of other situations where you might qualify.

Hopefully you now have a better idea of when you can get a Medicare Supplement plan with guaranteed issue. Do you still have questions, or would you like help finding a Medigap plan that fits your situation? I’d be glad to help. To get started, use the links below to set up a phone call to discuss your needs or receive a personalized email with plan options. If you’d rather look over plans on your own, just click the Compare Plans button on this page to view plan options in your area.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

 

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