Medicare Supplement plans have certain “Guaranteed Issue” periods that allow individuals to apply for a plan without denying you coverage, excluding your pre-existing conditions, or charging you more because of any health conditions. These guaranteed issue (GI) rights are Federally-mandated by the Centers for Medicare & Medicaid Services and apply to you all Medicare-enrollees who are in one of these specific situations.
The GI rights generally occur when your current health care coverage is changing in a certain way or you are involuntarily losing your coverage. Specific insurance companies may create their own GI situations, and they do; however, there are seven Federally-prescribed GI situations that all Medicare Supplement insurance companies must follow. If you fall into one of these periods, you should be able to sign up for a Medicare Supplement plan on a Guaranteed Issue basis. These seven situations are:
- You have employer or union coverage that pays AFTER Medicare, and that coverage is ending.
- You are enrolled in a Medicare Advantage plan, and this plan is leaving the Medicare program, stops servicing your area, OR you are moving out of the plan’s specific service area.
- You have a Medicare SELECT policy, and you are moving out of the plan’s service area. You can keep your current policy, but you do have the right, on a GI basis, to switch to a new policy.
- Your Medicare Supplement company goes bankrupt, which causes you to lose coverage. OR, you lose Medicare Supplement plan coverage through no fault of your own.
- You enrolled in a Medicare Advantage plan or PACE when you were first eligible to enroll, and within a year of joining, you wish to switch back to “original” Medicare (and a Medicare Supplement plan).
- You dropped a Medicare Supplement to switch to a Medicare Advantage or Medicare SELECT policy for the first time. You have been in that plan for less than a year and wish to switch back to Medigap.
- You decide to drop a Medigap policy or leave a Medicare Advantage plan because the company hasn’t followed the rules or misled you in some way.
Individual states also have the authority to create additional GI situations, and some have done so. Also, some of the specific GI situations have particular requirements for the plans that you can go into. For example, you may be eligible for a GI into a Medicare Supplement plan; however, it may have to be one of certain plans.
It is advantageous for you to be aware of these guaranteed issue situations if you are on Medicare. If you fall into one of them and elect not to sign up for a plan while that GI period is in effect, you will, most likely, have to qualify medically for a Medicare Supplement if you do decide to sign up at a later time.