What is Medicare Insurance Guaranteed Issue?

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Medicare Insurance Guaranteed issue right under the Medigap program refers to certain situations where by law, companies are required to offer you a Medicare supplement insurance plan regardless of your health status.

Even if you have pre-existing conditions, Medicare Supplement Insurance Plan companies cannot deny you coverage during these periods. Not only must companies offer you a plan, but the plans they offer must cover your pre-existing conditions without raising premiums.

Likewise, if you already have a policy, you have rights to protect yourself from being forced to keep a plan that is not right for you and in certain situations; you may have an additional guaranteed issue right available to you.




What Situations Trigger Medicare Guaranteed Issue Rights?

Situation What Plans Can You Buy?
You are in a Medicare Advantage plan, and:

  • The plan loses its contract with Medicare, or
  • The plan is discontinued in your service area, or
  • You move out of the plan’s service area
 Medigap Plan A, B, C, F, K, or L
You have Original Medicare (Part A and Part and a group health plan (including retiree or COBRA coverage), and:

  • Your group coverage is ending
 Medigap Plan A, B, C, F, K, or L
You have Original Medicare and a Medicare SELECT policy, and:

  • You move out of the Medicare SELECT network area
 Medigap Plan A, B, C, F, K, or L
You have a Medigap policy, and:

  • Your insurance company goes bankrupt and you lose your coverage, or
  • Your coverage ends for reasons that are not your fault
 Medigap Plan A, B, C, F, K, or L
You leave your Medicare Advantage plan or cancel your Medigap policy because:

  • The company committed fraud, or
  • The company misled you
 Medigap Plan A, B, C, F, K, or L

 

In these situations, an insurance company:

  • Must sell you a Medigap policy.
  • Must cover all your pre-existing health conditions.
  • Can’t charge you more for a Medigap policy because of past or present health problems.

In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way. Additionally, individuals enrolled into a Medicare Supplement Insurance Plan have a period of time (this varies by state but typically it is 30 days) when they are first enrolled in what is known as a “free look period”. During this period, you can decide whether or not you wish to keep your new plan.

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