Guaranteed Issue Rights Explained

Also called Medigap protections, guaranteed issue rights provide peace of mind that you can apply for a Medicare Supplement (Medigap) policy that covers you despite any pre-existing conditions in certain situations. As a result, insurance companies can’t refuse to sell you a Medigap policy no matter what illnesses you face if you apply for a Medigap plan when you have guaranteed issue rights.

These entitlements protect you from medical underwriting, so any past or present health conditions won’t inflate the price you pay for Medigap plan premiums. Understanding guaranteed issue rights and when they apply can help you take advantage of these safeguards.

You can compare Medigap plans online, and a licensed insurance agent can help you determine if you qualify for guaranteed issue rights.

Who Qualifies For Guaranteed Issue For Supplementary Health Insurance?

The most common circumstance when you have Medigap guaranteed issue rights is during your Medigap open enrollment period. Your Medigap open enrollment period lasts for 6 months, and it starts as soon as you are at least 65 years old and are enrolled in Medicare Part B. You have guaranteed issue rights during these 6 months.

If you are a Medicare beneficiary and your health care coverage or circumstances change, you may have guaranteed issue rights.

You will typically qualify for guaranteed issue rights in the following circumstances:

• Your Medicare Advantage plan leaves Medicare.
• Your Medicare Advantage plan stops coverage in your area.
• You move out of the service area for your Medicare Advantage plan.
• You have Original Medicare and an employer group health plan (including retiree or COBRA plans) or union coverage which ends.
• You have Original Medicare and a Medicare SELECT policy, but you move away from the Medicare SELECT policy service area.
• You joined a Medicare Advantage plan when you became eligible for Medicare at 65 but decided to switch to Original Medicare within 12 months. This is also called a trial right.
• You joined a Program of All-inclusive Care for the Elderly (PACE) when you became eligible for Medicare at 65 but opted to switch to Original Medicare within 12 months. This is also a trial right.
• You switched from a Medigap policy to a Medicare Advantage plan or Medicare SELECT policy for the first time but chose to switch back within 12 months. This is another trial right.
• Your current Medigap provider becomes bankrupt, and you lose your coverage.
• Your Medicare Advantage or Medigap provider misleads you or doesn’t follow the rules, so you decided to leave them.
• Other situations apply, meaning you lose Medigap coverage through no fault of your own.

If you’re facing more than one of the above circumstances, you can choose the guaranteed issue right that gives you the best Medigap option.

Do Popular Medicare Plans Allow For Guaranteed Issue?

Yes, if you have guaranteed issue rights, you can choose from a selection of plans, including the popular Plan F and G, if you qualify. Eligibility depends on your state and the circumstances that prompted your Medigap protections. 

Plan F

Plan F is the most inclusive Medigap plan, but it isn’t available to anyone who became eligible for Medicare on or after January 1, 2020. However, in most cases, you can buy Plan F if you became a Medicare beneficiary before this date. 

Plan G

After Plan F, Plan G has the most benefits, and you can apply for it it under guaranteed issue circumstances if you meet one of the situations outlined above. There is also a high-deductible Plan G option that you may be able to apply for if it’s available where you live.

What Is the Difference Between Medigap Open Enrollment and Guaranteed Issue?

An insurance company must sell you a competitive Medigap plan during your Medigap open enrollment period because you have guaranteed issue rights in this situation. 

However, there are differences between open enrollment and guaranteed issue, including:

• When they occur: Your Medigap open enrollment period occurs during the six months after you are at least 65 and first have Medicare Part B. Outside of your Medigap open enrollment period, you may qualify for other guaranteed issue rights any time you have qualifying circumstances.
  
  
• How often they occur: You have only one Medigap open enrollment period. Guaranteed issue rights may apply at various times while you have Medicare and could potentially happen more than once.
  
  
• The Medigap plans you can purchase: You can buy any Medigap policy available to new beneficiaries in your state during your Medigap open enrollment, as long as you meet general eligibility criteria. The same should typically apply if you’re outside of your Medigap open enrollment period but have guaranteed issue rights for other reasons.

How Long Is the Guaranteed Issue Period for Medicare?

If you know your circumstances are changing and guaranteed issue rights will apply, you may be able to apply for a Medigap policy as early as 60 days before the changes occur. 

Once your coverage ends, or you get an end notice or a claim denial, the guaranteed issue period runs for 63 calendar days.

Can You Be Denied a Medicare Supplement Plan?

You cannot be denied a Medigap plan during open enrollment or during other periods when you have guaranteed issue rights. Nevertheless, insurance companies can refuse you coverage or charge you higher premiums based on your health if you apply at other times. Denial is more common if you have severe, chronic health conditions.

Open enrollment is usually the best time to get a Medigap plan, as you’re guaranteed coverage at a competitive rate. That said, if your circumstances change, you may qualify for guaranteed issue rights which give you all the perks of open enrollment outside your first six months with Medicare.