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Your Medigap Protections Under the Law

October 6, 2016

Medicare Supplement guaranteed issue rights, also referred to as Medigap protections, are privileges you have under a defined set of circumstances, when insurance companies are required to sell you a Medicare Supplemental Insurance (Medigap) plan even if you have a pre-existing health condition.

When your circumstances dictate that you have guaranteed-issue rights, a Medicare Supplement plan provider is required by law to sell or offer you a Medicare Supplement policy and cover your pre-existing conditions. The plan provider also cannot charge you a higher monthly premium because of current or past health problems, although a waiting period may apply.

Guaranteed issue rights circumstances for Medicare Supplement (Medigap) plans

You have guaranteed-issue rights to a Medicare Supplement plan under these circumstances:

  • You’re notified that the Medicare Advantage(Medicare Part C) plan in which you are enrolled is discontinuing the plan in your area. In this case, you have guaranteed-issue rights for Medicare Supplement plans A, B, C, F, K, and L.
  • You have Original Medicare, Part A and Part B, alongside an employer or union health plan (including retiree or COBRA benefits) that will be discontinued. In this case, you have guaranteed-issue rights for Medicare Supplement plans A, B, C, F, K, and L.
  • You have Original Medicare, Part A and Part B, and a Medicare SELECT plan, and you move out of the SELECT plan’s coverage region. In this case, you have guaranteed issue rights for Medicare Supplement plans A, B, C, F, K, and L.
  • You joined a Medicare Advantage or PACE plan at age 65, when you first became eligible for Medicare Part A, and then decide to switch to Original Medicare, Part A and Part B, during your first year of enrollment. If so, you have guaranteed-issue rights to buy any Medicare Supplement policy available in your state.
  • You ended your previous coverage in a Medicare Supplement plan in order to enroll in a Medicare Advantage plan and, in less than a year since enrollment, you wish to go back to Medicare Supplement. In this circumstance, you may re-enroll in your prior Medicare Supplement plan with guaranteed-issue rights. If that plan is not available, you may enroll in Medicare Supplement plans A, B, C, F, K, and L with guaranteed issue rights.
  • You cancel your current Medicare Supplement policy or Medicare Advantage plan because the insurance company misled you. In this case, you have guaranteed issue rights for Medicare Supplement plans A, B, C, F, K, and L.
  • Your insurance company goes bankrupt or you lose your Medicare Supplement coverage through no fault of your own. You have guaranteed-issue rights to purchase Medicare Supplement plans A, B, C, F, K, and L.

Be aware that if you reside in Massachusetts, Minnesota, or Wisconsin, you will have different Medicare Supplement plan options, since these three states do not offer the standardized 10 Medicare Supplement plans.

It’s also important for you to know that Medicare Supplement plans are “guaranteed renewable”, which means that your enrollment in a Medicare Supplement plan cannot be terminated by your insurance company unless you provide false information to the plan, commit fraud, or fail to pay your monthly premiums.   

When to enroll in a Medicare Supplement (Medigap) plan

In the conditions noted above you have guaranteed-issue rights to Medicare Supplement plans, even if you have a pre-existing health condition. If you’re joining a Medicare Supplement plan during the Open Enrollment Period (OEP), the plan is only allowed to make you wait a maximum of six months for coverage to take effect, for services related to your pre-existing health condition.

However, be aware that if you’re joining a Medicare Supplement plan outside of the Open Enrollment Period and without one of the stated conditions, you may not have guaranteed-issue rights. In that case, a Medicare Supplement plan may use medical underwriting to decide whether to accept your application for enrollment and what to charge you for your plan. To receive the health coverage you need and make the most out of your guaranteed-issue rights, you may want to plan ahead and purchase a Medicare Supplement plan during the OEP.