What is a guaranteed issue right?

A guaranteed issue right allows you to purchase a Medicare Supplement insurance policy from any company without regard to your health condition. You only have a guaranteed issue right in certain situations.

According to Medicare.gov, when you have a guaranteed issue right, insurance companies are lawfully required to sell or offer you a Medicare Supplement insurance policy even if you have pre-existing conditions. In these situations, insurers cannot charge you more because of past or present health problems.

If you do not buy a policy during your Medigap open enrollment period or a situation in which you have a guaranteed issue right, you will likely be required to go through medical underwriting. Medical underwriting could lead to a coverage denial or higher premiums.

Situations where you may have a guaranteed issue right

The following 8 situations may provide you with a guaranteed issue right that allows you to buy a Medigap policy after your Medigap open enrollment period ends. An insurance company cannot refuse to sell you a Medigap policy in the following situations:

  1. You have a Medicare Advantage plan & it is leaving Medicare or ending coverage in your area.
  2. You have a Medicare Advantage plan & you are moving out of the plan’s service area.
  3. You have Medicare Parts A and B (Original Medicare) & you need to replace an employer health plan that will soon be discontinued.
  4. You have Original Medicare and a Medicare SELECT policy & you move out of the policy’s service area.
  5. You joined a Medicare Advantage plan or PACE when you were first eligible for Medicare Part A at 65 & within the first year of joining you want to switch to Original Medicare.
  6. You dropped a Medigap policy to join a Medicare Advantage plan for the first time & within the first year of joining you want to switch back to Medigap.
  7. Your Medigap insurance company goes bankrupt or ends your policy through no fault of your own.
  8. You leave a Medicare Advantage plan or Medigap policy because the company misled you or did not follow the rules.

Applying for a policy when you have a guaranteed issue right

If you get a Medigap policy through a guaranteed issue right, you will have guaranteed access only to certain standardized plans. You will be able to enroll in one of the following Medigap plans sold in your state: Plans A, B, C, F, K, or L. (If you live in Wisconsin, Massachusetts, or Minnesota, however, you do not have access to these plan options.)

In some situations where you have a guaranteed issue right, you will need to apply for a new policy no later than 63 days from the date that your current coverage ends. See Medicare.gov for more details.

In order to make the transition to a new Medigap policy as smooth as possible, keep any documents, claims, or envelopes that your Medigap or Medicare Advantage provider sends to you. These items may be necessary to prove that you qualify for a guaranteed issue right.

To prevent any breaks in Medigap coverage, you should apply for a new Medigap policy before your current policy ends. On the day that your current policy ends, you will be able to start your new policy.

For more information about guaranteed issue rights and enrolling in a policy after your open enrollment period, please contact us.

 

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