MEDICARE SUPPLEMENT: GUARANTEED ISSUE
Guaranteed issue is complicated and it can be difficult to know whether or not you qualify for this Medicare Supplement. Read on to learn more about your rights when it comes to Medigap plans and how they can apply to your situation.Guaranteed issue is one of the most complicated and misunderstood concepts when it comes to Medicare Supplement insurance. Even if you have guaranteed issue rights, Medicare might still put restrictions on the type of policy you can buy and the amount of time you have to apply.
The guaranteed issue rights to which some Original Medicare beneficiaries have access typically apply outside of an open enrollment period. In other words, you’re not within the initial time frame to apply for Medigap plans, so you need another reason to become eligible.
Let’s take a deeper look at guaranteed issue rights for Medicare Supplement insurance to figure out how you might qualify for them.
YOU NO LONGER HAVE ACCESS TO YOUR MEDICARE ADVANTAGE OR MEDICARE SELECT PLAN
If you currently have a Medicare Advantage or Medicare SELECT plan, you can qualify for guaranteed issue rights when that coverage is no longer available to you. You might move out of the plan’s service area, for instance, or the insurance company may stop offering your plan. This can also happen when your insurance company drops out of Medicare.
In these situations, you no longer have access to your health insurance, so you can start shopping for Medigap plans in your area. Guaranteed issue rights will stop you from being penalized for applying for Medicare Supplement plans because you have no control over your situation.
Keep in mind, though that the clock will run out. Under these circumstances, you can apply for Medicare Supplement insurance up to 60 days before your insurance coverage ends and up to 60 days afterward. That gives you a roughly four-month window, but the faster you look for coverage, the better.
YOUR GROUP COVERAGE STOPS COVERING YOUR MEDICAL CARE
Guaranteed issue rights can also apply if you’ve been covered by group coverage, typically through your employer, but that coverage is coming to an end. This scenario also applies to beneficiaries of COBRA, which is when you pay to keep your group coverage active after you leave your job, or you have retiree coverage.
When your group coverage ends, you have a limited window of time to apply for a Medicare Supplement plan. As soon as you’re notified that your group coverage will no longer pay for your healthcare claims, you have 63 days to apply for Medigap plans.
How you get notified varies by insurance company. You might get a letter in the mail or a phone call, for instance, either of which starts the clock. If a claim gets denied, you may call your insurance company to inquire, and only then learn you’ve lost access to coverage. At that point, your 63-day window for applying to Medicare Supplement insurance companies opens.
Unfortunately, you’re limited to specific plans: Medigap plans A, B, C, F, K, and L. Medigap plans D, G, M, and N aren’t available to Original Medicare beneficiaries who are applying after losing group coverage.
YOU DON’T LIKE MEDICARE ADVANTAGE
Medicare allows beneficiaries a “trial period” for Medicare Advantage that lasts one year. If you decide you don’t like Medicare Advantage, you have guaranteed issue rights to apply for Medicare Supplement plans and change your healthcare coverage.
You must have gotten your Medicare Advantage plan when you first turned 65 and became eligible for Original Medicare. Additionally, you have a window of 60 days before and 63 days after your Medicare Advantage healthcare coverage ends to apply for Medigap plans.
This guaranteed issue right also applies to retirees who have a Program of All-Inclusive Care for the Elderly (PACE) plan.
YOU WANT TO SWITCH BACK TO A MEDICARE SUPPLEMENT PLAN
Let’s say that you first applied for Medigap plans when you reached retirement age. You tried out Medicare Supplement insurance, but decided to switch to a Medicare Advantage or Medicare SELECT plan before the first year ended. In this case, you have guaranteed issue rights.
This is also called a trial right. It gives you the opportunity to try out a different type of plan, then change your mind. Your rights are limited, though. You have to switch back to the plan letter you originally bought unless it’s no longer available. In that case, you can choose from Medigap plans A, B, C, F, K, and L.
YOU LOSE ACCESS TO YOUR MEDIGAP COVERAGE
Medicare doesn’t penalize beneficiaries who lose their Medicare Supplement coverage through no fault of their own. If your insurance company closes its doors or goes bankrupt, for instance, you have no control over the outcome. Consequently, you get guaranteed issue rights for Medigap plans.
Keep in mind that this right doesn’t extend to beneficiaries who lose their coverage through fault. Let’s say you stop paying your Medicare Supplement premiums. In that case, you wouldn’t have guaranteed issue rights.
YOUR INSURANCE COMPANY BREAKS THE LAW
The final way in which you can qualify for Medicare Supplement guaranteed issue rights is when your insurance company commits fraud or otherwise fails to follow the law. That’s not your fault. When your coverage ends, you have 63 days to choose another insurer for Medigap plans A, B, C, F, K, or L.
Guaranteed issue rights aren’t something you should count on when it comes to Medicare Supplement insurance unless you’re exercising a trial right. You can’t predict whether your insurer will go out of business, for instance.
However, if an unexpected loss of coverage occurs, you should know your rights so you continue to take advantage of your preferred Medicare Supplement plan. You must also keep in mind that all guaranteed issue rights come with time limits. Failing to act quickly can result in the loss of those rights.
If you have guaranteed issue rights, or if you’ve just turned 65 and are ready to apply for Medigap plans, it’s time to be proactive about Medicare Supplement insurance. Use Ensurem’s useful Medigap Quoter to get quotes from insurance companies in your area.