Guaranteed Issue (GI) rights, also known as “Medigap Protections,” are your right to have guaranteed access to certain Medicare Supplement policies when specific situations occur. Generally, you qualify for a Guaranteed Issue if your coverage or service area changes.
But other ways exist to qualify for a Guaranteed Issue Right, meaning insurance companies can’t deny you a Medigap policy. Let’s learn more about Guaranteed Issue rights, the scenarios that need to occur, why these rights are beneficial, and how you can take advantage of your Guaranteed Issue Period.
What is a guaranteed issue right for Medicare beneficiaries?
Medigap protections for Medicare beneficiaries allow you to buy a Medicare Supplement without going through underwriting. When you avoid underwriting, you get the best possible health ratings, meaning the cost is slightly lower, and you can’t be denied coverage.
Since private insurance companies sell Medigap companies, they can deny people coverage based on the individual’s health. Once you have too many health issues, enrolling in Medigap becomes impossible.
Another great thing, with Guaranteed Issue rights, you don’t have a pre-existing condition waiting period. But it’s important to note that using a Guaranteed Issue window only allows you to buy specific plans.
The Medigap plan options for GI rights are Plan A, B, C, D, G, F, K, or L. You must be eligible for Medicare before 2020 to qualify for Plan C and F, but you won’t qualify for Plan G. Those eligible after 2020 qualify for Plan G but not Plan C or Plan F.
What scenarios need to occur to qualify for guaranteed issue rights?
Usually, specific situations must occur for you to qualify for a Guaranteed Issue right. Qualifying situations include losing coverage through no fault of your own, moving out of the plans service area, or if you qualify for a “Trial Right.”
What happens if I lose coverage through no fault of my own?
Losing coverage isn’t your fault when the plan leaves Medicare or stops providing coverage in your area. If your Medigap company goes bankrupt, that’s not your fault. Also, if you leave a Medicare Advantage plan or drop a Medigap plan because the company misled you or didn’t follow the rules, you qualify for Guaranteed Issue Rights.
Also, it’s not your fault if your employer, union, COBRA, or retiree coverage plan ends. If that happens to you, you’ll qualify for a Guaranteed Issue. Just make sure to have your proof of coverage readily available.
Will I qualify for guaranteed issue rights if I move?
You’ll qualify for Guaranteed Issue Rights when you notify Medicare and the insurance plan of your move. If you have a Medicare SELECT policy and move out of the SELECT policy service area, you’ll qualify for Guaranteed Issue Rights.
What “trial rights” qualify for guaranteed issue?
Sometimes you don’t know if something is right for you until you try it. If you drop a Medigap policy to enroll in a Medicare Advantage or Medicare SELECT policy for the first time, you have the plan for less than 12 months, and you want to change back, then you qualify for a “Trial Right.”
Also, if you join a Part C plan or PACE as soon as you’re eligible for Medicare, within the first 12 months of signing up, if you decide you want Medigap, you’ll be eligible to switch. After 12 months, you won’t qualify for Medigap protections through the “Trial Right.”
What states have Medigap guaranteed issue rights?
A few states have made laws that make Medigap more accessible. These benefits are only state-specific. If you don’t live in the state mentioned, the rule doesn’t apply.
For example, California and Oregon have the “birthday rule” where each year, during the time of your birthday, you can switch from one Medigap plan to another one with the same or fewer benefits and still avoid underwriting.
Starting in March of 2022, Idaho beneficiaries can use the “birthday rule” to change to a different Medigap plan; the window starts on their birthday and lasts for 63 days.
Those in Illinois between the ages of 65-75 have 45 days after their birthday to make changes to their Medicare Supplement plan without underwriting. They must choose a policy that has the same or less coverage.
In Connecticut and New York, Medicare Supplement plans are guaranteed issue all year round but don’t be surprised to find that the premiums are higher in these states than in states without this rule. This rule isn’t available in other states.
In Maine, you qualify for GI rights all year if you don’t have any gaps in coverage that lasted longer than 90 days since you first signed up for a Medicare Supplement.
Massachusetts prohibits Medigap insurance companies from implementing pre-existing condition waiting periods. Also, Medigap companies must offer GI from February 1st to March 31st every year. Insurance companies can participate in continuous Medigap protections for the year.
In Missouri, you can choose a new policy with GI rights once per year on the anniversary of your plan.
If you live in Nevada, you can change your Medigap plan to another one with the same or less coverage with no underwriting. The time to change starts the 1st day of your birthday month and lasts 60 after.
Washington state law allows Medicare beneficiaries with Plan A to switch to another Plan A without underwriting. Now, with any other plan, you can get more coverage and still avoid underwriting.
Insurance companies in Vermont offer Medigap policies with Guaranteed issues all year long.
What is the difference between guaranteed issue and Open Enrollment?
With the Open Enrollment Period, you can select any policy and avoid underwriting, there are more limits with Guaranteed Issue. During the Open Enrollment Period, you’re new to Medicare Part B and likely younger, meaning the premium cost could be lower.
With Guaranteed Issue rights, you likely need documents proving you had coverage. The documents would need to show when coverage ends, and there is usually a limit on how many days you can go without coverage before you no longer qualify for GI rights.
Is Part D guaranteed issue?
Yes, Part D prescription drug plans are Guarantee Issue because these plans are available to anyone. If you sign up for Part D long after you’re first eligible for Medicare, you could incur a Part D late enrollment penalty. But, delaying enrollment means a higher cost, it doesn’t exclude you from coverage.
Are Medicare Advantage plans guaranteed issue?
Medicare Advantage plans are now available to those with End-Stage Renal Disease. So, in essence, these plans are available to anyone living in a plan’s service area.
These plans change every year, so comparing your options is essential if this is the kind of plan you currently rely on for coverage.
Are Medicare Supplements guaranteed renewable?
Yes, Medigap plans are Guaranteed Renewable. Once you sign up for coverage, you can stay on that plan as long as you like. But in some cases, changing plans will make sense.
How do I find a Medigap plan during the guaranteed issue rights period?
Finding a Medigap policy during the Medigap Protections period is easy because you qualify for so many options. Also, avoiding underwriting is super beneficial to you.
You can compare Medigap plans online or talk with a licensed insurance agent to better understand what’s available to you. Give us a call at the number above to see plans in your area compared side by side.
Or fill out an online rate comparison form to see what is available to you in your area.
