We get a lot of questions when it comes to Medigap guaranteed issue rights, also known as Medicare Supplements. Unlike Medicare Advantage plans, which do not require underwriting, Medicare Supplements will require underwriting if you do not qualify for a guaranteed issue right.
Keep reading to learn more about:
- What is Medigap guaranteed issue?
- What are the Trial Rights scenarios for guaranteed issue?
- What are the other guaranteed issue scenarios?
What is Guaranteed Issue?
Medigap Guarantee Issue is when insurance companies are obligated to sell Medicare Supplement plans to individuals without considering pre-existing conditions, medical history, or charging higher premiums based on health status. This means you can enroll in a Medicare Supplement plan without going through underwriting. If you do not have a guaranteed issue right, then you will have to go through health underwriting by the insurance companies. If you have a lot of health issues, then you could get a much higher rate or be completely denied coverage.
It is important to note that not all guaranteed issue scenarios mean you can enroll in any Medicare Supplement plan. Some situations limit the plan you can enroll in. To make it easier, we put together a list of Guaranteed Issue scenarios with information on plans that you can enroll for each situation.
When is Your Medigap Open Enrollment Period?
All newly eligible Medicare beneficiaries qualify for guaranteed issue when they first enroll in Medicare. This marks the primary opportunity for individuals to enroll in a Medicare Supplement plan without underwriting. During this period, you may enroll in any plan available in your area. This 6-month period starts the first day of the month you turn 65 and are enrolled in Part B. If you continued working past 65 and delayed Part B until you retired, then your Medigap Open Enrollment starts the month your Part B starts. Please note, you must also have Part A to enroll in a Medigap plan.
Trial Right Guaranteed Issue (Joined MAPD When First Eligible):
The Trial Right is for people who joined a Medicare Advantage plan when they were first eligible at age 65 and disenrolled within 12 months. As the name suggests, this allows people to “try” Medicare Advantage plans first without losing their Medigap guaranteed issue right. In this scenario, your Medicare Advantage start date must have started the same month as your Part A and Part B. If either of these start dates are different, then you will not get guaranteed issue. If you qualify for the Trial Right Guaranteed Issue, then you can enroll in any Medicare Supplement plan in your area.
Example: Joe’s birthday was 2.15.59. His Medicare Part A and Part B effective date was February 1st 2024. Joe chose a Medicare Advantage plan to start February 1st as well, the same time as his Part A and Part B. Because his A, B, and MAPD effective dates are the same and he enrolled the month he turned 65, Joe can disenroll from his MAPD plan anytime within 12 months of his start date. He can enroll in any Medicare Supplement plan without underwriting.
Trial Right Guaranteed Issue (Dropped Medigap to join MAPD):
There are two different Trial Rights for people to try a Medicare Advantage plan and switch to a Medicare Supplement without underwriting. This version of the Trial Right is for those people who dropped an existing Medicare Supplement plan to join a Medicare Advantage plan for the first time. Per Medicare, if you had a Medicare Supplement plan at any time before you joined a Medicare Advantage plan, then you have 12 months to “try” the plan. You will have a Medigap guaranteed issue to return to the plan within 12 months of first joining the MAPD. However, you cannot join any Medicare Supplement in this situation! You can only buy the same plan you had before enrolling in the Medicare Advantage plan. If the same insurance company no longer sells that plan, then you can buy Medigap plan A, B, C*, D, F*, G, K, or L offered by a company in your state. Some carriers include plan N. (plan C and F is only available if you were enrolled in Medicare prior to Jan 1st, 2020)
Example: Mary is 75 and her plan F premium continues to get more expensive each year. She has had her plan since she retired at age 68. She wants to try a Medicare Advantage plan because the premiums are much lower but is nervous if it is right for her. During the Annual Election Period, she decides to drop her supplement and enroll in an MAPD plan for January 1st effective date. Mary has 12 months to decide if she likes the MAPD plan or not. If not, she will have a Special Enrollment Period to disenroll from her MAPD plan and rejoin her original Medicare Supplement. She will not have to go through underwriting if she joins her same plan.
Medicare Open Enrollment Due to Loss of Employer Coverage and Active Employment:
If you continued working past 65 and delayed Part B, then you may have a Medigap guaranteed issue to enroll in a Medicare Supplement. This assumes you maintained creditable coverage and had active employment with your employer. When you are ready to retire, you can enroll in Part B and you will qualify for guaranteed issue. Your Medigap Open Enrollment Period will start once you sign up for Part B. After you sign up for Part B, you’ll have 6 months to enroll in a Medicare Supplement plan. This is true even if you sign up while you still have employer coverage.
Example: Louise is 68 and retired May 1st. She delayed enrolling in Part B because she had creditable coverage through her employer. She enrolled in Part B starting May 1st. It is now June, and she is finally ready to enroll in a Medicare Supplement. She can still enroll using her Medigap Open Enrollment period with guaranteed issue. She has 6 months from May 1st to enroll. (NOTE: However, she only has 63 days to pick a Part D plan from the end of her employer group coverage).
You have Original Medicare plus an employer group health plan (including retiree or COBRA coverage) or union coverage that pays AFTER Medicare pays and that plan is ending?
What if you enrolled in Original Medicare Part A and Part B while still working and had group coverage? If you have Original Medicare and the other insurance is second payer, which pays after Medicare pays, then you will get a guaranteed issue right when that plan ends. Your enrollment window is smaller than in the previous scenario. You will have 63 days after the date your other coverage ends to enroll in a Medicare Supplement. If you have COBRA coverage, you can either enroll in a plan right away or wait until your COBRA coverage ends.
Example: Nancy is 66, still works, and has employer coverage through her small employer of only 15 employees. Even though she has coverage through her employer, she still had to enroll in Part A and Part B. In this situation, her employer coverage is second payer to Medicare when she seeks care because the company is small with less than 20 employees. She is now planning to retire and will lose her employer group coverage starting August 1st. She can enroll in any Medicare Supplement plan in her area without underwriting for 63 days (plan C and F is only available if you enrolled in Medicare prior to Jan 1st, 2020).
Currently enrolled in an MAPD and Move Out of Area?
If you move out of your Medicare Advantage plan’s service area, then you can qualify for guaranteed issue. This is because your current plan is not available in the new area. You can enroll in any Medicare Supplement in the new area without underwriting.
Example: Charles is 68 years old and lives in Tucson, Arizona. He currently has a Medicare Advantage plan. He will be moving to Flagstaff, AZ next month, but this is outside of his current plan’s area. Since he cannot keep his current plan in Flagstaff, AZ, he can either pick a new Medicare Advantage plan or he can enroll in a Medicare Supplement without underwriting. He has 63 days from the date his MAPD plan ends to apply for the new Medicare Supplement plan. He can enroll in any plan sold by any insurance company in the new state except plan C or F. This is because he became eligible for Medicare after January 2020.
Currently Enrolled in a Medicare Supplement Plan and Move to a New Service Area?
If you move to a new service area, you can keep your current policy as long as you still have Original Medicare. This is because you can go to any provider that accepts Original Medicare, regardless of which state you are in. Your move generally does not trigger a guaranteed issue status in this situation. However, if your current company doesn’t operate in your new state of residence then you may be able to buy a new Medicare Supplement without underwriting. You do need to let your current company know of the move. They may adjust the rate based on the new location or let you keep your current rate. This could be higher or lower. If you want to change to a new Medicare Supplement plan, you will need to go through underwriting.
Example: Jerry is moving from Minnesota to Arizona. He currently has a BCBS of MN medigap policy, but Minnesota does not have some standardized letter plans like Plan G. They are standardized differently. Since Jerry is moving to Arizona, where Plan G is offered, he will have guaranteed issue to join Plan G or any other plan that Minnesota doesn’t offer. He will not go through underwriting.
You have a Medicare Advantage Plan and your plan cancels in your area or leaves Medicare:
If your current Medicare Advantage plan is gets cancelled, then you have the right to enroll in Medigap Plan A, B, C* D, F*, G, K, or L (plan C and F is only available if you were enrolled in Medicare prior to Jan 1st, 2020). You will have guaranteed issue without underwriting in this situation. You must apply for a plan 60 days before the date your Medicare Advantage Plan coverage ends, or no more than 63 days after your Medicare Advantage Plan coverage ends. Note: Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.
Example: George received notice in September that his current Medicare Advantage plan would not renew in January. George is forced to pick a new plan or will be without coverage in January. Because his plan is ending, he will have a guaranteed issue to join a Medicare Supplement without underwriting. George started Medicare in 2021 so he does not qualify for Plan C or Plan F. He can submit his application for a Medicare Supplement in October for a January start date.
You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area.
If you have a Medicare SELECT policy and move out of the service area, you qualify for a guaranteed issue to enroll in a Medicare Supplement in the new area. You may enroll in Plan A, B, C*, D, F*,G, K, or L that’s sold by an insurance company in your state ((plan C and F is only available if you were enrolled in Medicare prior to Jan 1st, 2020). You have up to 63 days after your Medicare SELECT ends to enroll in a Medicare Supplement.
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