Guaranteed Issue Insurance

Guaranteed Issue Insurance

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Guaranteed Issue Insurance

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Medicare Supplemental Insurance Medicare Supplement Information Guaranteed Issue Insurance

Guaranteed Issue Insurance

Guaranteed Issue Rights (sometimes called "Medigap protections") are rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy even if you have health problems (called "pre-existing conditions.").

In these situations, an insurance company:

  • Must sell you a Medigap policy,
  • Must cover all your Pre-existing conditions and
  • Can’t charge you more for a Medigap policy because of past or present health problems.

In many cases, you have a guaranteed issue insurance right when you have other health coverage that changes in some way, such as when you lose or drop the other health care coverage. In other cases you have a "trial right" to try a Medicare Advantage Plan and still buy a Medigap policy if you change your mind.

An insurance company can’t refuse to sell you a Medigap policy under the following situations:

Guaranteed Issue Insurance Right Situation #1…

Your Medicare Advantage Plan is leaving the Medicare Program, stops giving care in your area, or you move out of the plan’s service area.

Note: If you immediately join another Medicare Advantage Plan, you can stay in that plan for up to one year and still have the rights in Situations #4 and #5.

You Have the Right to Buy…

Medigap Plan A, B, C, F, K, L, M, or N that is sold in your state by any insurance company.

For this right, you must switch to Original Medicare.

When to Apply for a Medigap Policy…

You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 calendar days after your health care coverage ends.

Guaranteed Issue Insurance Right Situation #2…

You are in Original Medicare and have an employer group health plan or union coverage that pays after Medicare pays, and that coverage is ending. This includes retiree or COBRA coverage.

Note: In this situation, state laws may vary.

You Have the Right to Buy…

Medigap Plan A, B, C, F, K, L, M, or N that is sold in your state by any insurance company.

If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.

When to Apply for a Medigap Policy…

You must apply 63 calendar days after the latest of these three dates:

  • date the coverage ends,
  • date on notice that coverage is ending (if you get one), or
  • date on claim denial, if this is the only way you know that your coverage is ending.

Guaranteed Issue Insurance Right Situation #3…

You are in Original Medicare and have a Medicare SELECT policy. You move out of the Medicare SELECT plan’s service area.

You can keep your Medigap policy or you may want to switch to another Medigap policy.

You Have the Right to Buy…

Medigap Plan A, B, C, F, K, L, M, or N that is sold by any insurance company in your state or the state you are moving to.

When to Apply for a Medigap Policy…

You can apply up to 60 calendar days before the date your coverage will end. You must apply no later than 63 calendar days after your coverage ends.

Guaranteed Issue Insurance Right Situation #4…

(Trial Right) You joined a Medicare Advantage Plan or PACE when you were first eligible for Medicare Part A at age 65 and within the first year of joining, you decide you want to switch to Original Medicare.

You Have the Right to Buy…

Any Medigap policy that is sold in your state by any insurance company.

When to Apply for a Medigap Policy…

You can apply up to 60 calendar days before the date your coverage will end. You must apply no later than 63 calendar days after your coverage ends.

Note: Your rights may last for an extra 12 months under certain circumstances.

Guaranteed Issue Insurance Right Situation #5…

(Trial Right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time; you have been in the plan less than a year and you want to switch back.

You Have the Right to Buy…

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If it included drug coverage, you can still get that same policy, but without the drug coverage.

If your former Medigap policy isn’t available, you can also buy a Medigap Plan A, B, C, F, K, L, M, or N that is sold in your state by any insurance company.

When to Apply for a Medigap Policy…

You can apply up to 60 calendar days before the date your coverage will end. You must apply no later than 63 calendar days after your coverage ends.

Note: Your rights may last for an extra 12 months under certain circumstances

Guaranteed Issue Insurance Right Situation #6…

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You Have the Right to Buy…

Medigap Plan A, B, C, F, K, L, M, or N that is sold in your state by any insurance company.

When to Apply for a Medigap Policy…

You must apply 63 calendar days from the date your coverage ends.

Guaranteed Issue Insurance Right Situation #7…

You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.

You Have the Right to Buy…

Medigap Plan A, B, C, F, K, L, M, or N that is sold in your state by any insurance company.

When to Apply for a Medigap Policy…

You must apply 63 calendar days from the date your coverage ends.

I lost (or dropped) my health care coverage. Can I buy a Medigap policy?

In some cases you have a guaranteed issue right to buy a Medigap policy. For example, if your health coverage ended. If you lost or dropped your health coverage or joined a Medicare Advantage Plan, make sure you keep

  • a copy of any letters, notices, and claim denials as proof of coverage
  • anything that has your name on it
  • the postmarked envelope these papers come in as proof of when it was mailed.

It’s important to keep this information because you may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right and don’t need to answer medical questions.

It’s best to apply for a Medigap policy before your current health coverage has ended. You can apply for a Medigap policy while you are still in your health plan and choose to start your Medigap coverage the day after your health plan coverage ends. This will prevent breaks in your health coverage.

Important: The guaranteed issue rights in this section are from Federal law. Many states provide additional Medicare rights. Call your State Health Insurance Assistance Program or State Insurance Department for more information.

There may be times when more than one situation applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice.

Related Resources:

Source: Medicare.gov (The Official U.S. Government Site for Medicare)

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