You may have come across the term “Guaranteed Issue Rights” and wondered how it applies to your particular Medicare situation. In a nutshell, guaranteed issue rights are rights you may have in certain circumstances that require insurance companies to offer you certain Medicare Supplement Insurance policies without requiring medical underwriting. This means your pre-existing conditions cannot be used to deny or charge you more for coverage. Read on to find out if you qualify for these special rights and how you can use them to make sure you get the coverage you want.
Guaranteed Issue Rights are also known as “Medigap protections,” because they can help protect your rights to qualify for Medicare Supplement Insurance coverage (also known as Medigap coverage). You may qualify for guaranteed issue rights if you experience one of the following circumstances:
- You move out of your plans coverage area. This typically applies to Medicare Advantage and Select plans, which have geographical networks of doctors and providers.
- You lose your Medicare Advantage or Medicare Supplement Insurance coverage through no fault of your own. This could be because the plan stops offering service in your area, your plan goes out of business, your plan stops contracting with Medicare or because your plan didn’t honor Medicare guidelines or mislead you in some way.
- You have Original Medicare and secondary health care coverage that ends for any reason. The secondary coverage you lost could include retiree, COBRA, employee health care or union coverage.
- You have a “trial right” which allows you to try a Medicare Advantage plan for the first time you are eligible since turning 65 and then after 12 months or less decide to switch to a Medicare Supplement Insurance plan instead. You may also be eligible for a trial right if you dropped a Medicare Supplement Insurance policy to try Medicare Advantage for 12 months or less and now wish to return to Original Medicare and sign up for a Medicare Supplement Insurance plan. In this case you would only be eligible for the Medicare Supplement Insurance that you originally qualified for. Keep in mind that some states or plans may allow a longer trial period.
Length of guaranteed issue rights can vary, but you generally have 63 days from the time of the triggering event to seek Medicare Supplement Insurance coverage with these special protections. Insurance companies may require you to prove that you qualify for a guaranteed issue right. To streamline this process make sure you save all documentation related to your circumstance such as letters, notices or emails terminating or denying coverage. If you are not sure if your circumstance qualifies you for a guaranteed issue right contact your state’s Health Insurance Assistance Program to get assistance.
If you have a guaranteed issue right the plans you qualify for depend on when you first became eligible for Medicare. If you were eligible before the year 2020 you can choose from plans A, B, C, F, K, or L. If you become eligible during the year 2020 or after then you can sign up for plans A, B, D, G, K, or L. As mentioned above if you already had a Medicare Supplement Insurance policy which you terminated to try Medicare Advantage your guaranteed issue right will only cover that particular plan (if it is still available). If for some reason that plan is no longer available you are eligible for plans A, B, C, F, K, or L if you qualified for Medicare before 2020 and plans A, B, D, G, K, or L if you qualified after 2020. If you have a trial right—and you have never had a Medicare Supplement Insurance policy before—then you have a guaranteed issue right for all the plan.