GUARANTEED ISSUE AND YOUR RIGHTSIf you don’t know your rights, you might miss out on opportunities to improve your healthcare coverage. Read on to learn what you need to know about Medigap and Medicare Supplement guaranteed issue.
As you get closer to age 65, you have lots of decisions to make. You might not always make the correct ones, but you can usually work out an alternative down the line. This is often true when it comes to Medicare Supplement guaranteed issue rights.
We’re not advising you to pick a Medigap plan out of a hat and go with it because you can always change it later. Medicare Supplement guaranteed issue only happens in certain circumstances, and you can’t assume you’ll be able to change your mind. Knowing your rights, however, can make you more secure in your healthcare.
First, we’ll explain what Medicare Supplement guaranteed issue is, and then we’ll provide six things you need to know to make use of it.
WHAT IS MEDICARE SUPPLEMENT GUARANTEED ISSUE?
Think of Medicare Supplement guaranteed issue as a benefit extended to you by Medicare that allows you to take advantage of certain situations if you want to change your healthcare plan. Specifically, you might want to move to a Medigap plan from a Medicare Advantage or Medicare SELECT plan, or you need to change to a Medigap plan because of extenuating circumstances.
Medicare allows guaranteed issue under very specific circumstances, and you always have a time limit on making the change. Your initial enrollment period might last for six months after you turn 65, but you could have as few as 63 days to make a switch under Medicare Supplement guaranteed issue.
1. YOU CAN GET MEDIGAP AFTER YOU EXIT YOUR GROUP INSURANCE
Many people continue to receive benefits as a result of group employment coverage after they turn 65. Perhaps you’re not ready to retire, or maybe your employer has agreed to continue your group coverage after you leave as part of your overall benefits package.
Whatever the case, when your group coverage ends, Medicare Supplement guaranteed issue allows you to select from Medigap plans A, B, K, and L. Medicare doesn’t penalize seniors who continue to work for their employers or who want to take advantage of group coverage.
If you have COBRA insurance, you can still apply for a Medigap policy. You’ll receive guaranteed issue rights even when the COBRA policy remains in effect.
2. YOU HAVE MEDICARE SUPPLEMENT GUARANTEED ISSUE IF YOUR MEDICARE ADVANTAGE PLAN DOESN’T SERVE YOUR NEW GEOGRAPHIC LOCATION
Medicare Advantage — also called Medicare Part C — plans don’t always serve all geographic regions. Let’s say that you have a Medicare Advantage plan in Texas, but you want to move to Florida. If your insurer doesn’t offer your plan in Florida, you have Medicare Supplement guaranteed issue to get a plan in your new home.
In this case, you have to return to Original Medicare first. If you move to Florida and pick up another Medicare Advantage plan, you won’t receive guaranteed issue rights should you decide you would prefer a Medigap plan instead.
For this situation, you can choose from Medigap Plans A, B,C, F, K, and L. Each offers a different level of coverage, so conduct thorough research before deciding which plan will serve your needs best.
3. GUARANTEED ISSUE RIGHTS APPLY IF YOUR INSURER DOES SOMETHING WRONG
Medicare won’t punish you if your insurer violates Medicare’s rules or the law, or if the company goes out of business. In these situations, you receive Medicare Supplement guaranteed issue rights. You can apply for one of the Medigap plans listed above without penalty.
An insurer might accidentally or purposefully mislead you about details of your benefits, for instance, or the company might declare bankruptcy. Since you can’t control these situations, Medicare allows you to choose another Medigap policy under Medicare Supplement guaranteed issue.
4. MEDICARE OFFERS CERTAIN TRIAL PERIODS
In certain situations, you can take advantage of Medicare Supplement guaranteed issue by availing yourself of a trial right. Essentially, this right gives you the opportunity to try out an alternative to Medicare. If you don’t like it, you can return to Medicare within a specific time frame and apply for a Medigap plan.
For example, maybe you joined a Medicare Advantage plan when you turned 65. You’ve had the plan for less than a year, but you want to switch to Medigap. Medicare Supplement guaranteed issue allows you to go back to Original Medicare and apply for any Medigap plan you want.
Similarly, you might have dropped the Medigap plan you joined when you turned 65 in favor of Medicare Advantage or Medicare SELECT. Now you want to switch back to Medigap. In this case, you’re allowed to return to Medigap within one year, but you must return to your original plan.
5. GUARANTEED ISSUE APPLIES IF MEDICARE ADVANTAGE SUBSTANTIALLY INCREASES YOUR PREMIUM OR PULLS OUT OF MEDICARE
Let’s say that you have a Medicare Advantage plan that has changed your benefits. In this case, you might qualify for Medicare Supplement guaranteed issue. The same is true if your insurer increases your premiums or copays by 15 percent or more.
The main caveat is that you have to stick with the insurer that provided your Medicare Advantage plan. If your insurer doesn’t offer Medigap, you can move to a different insurer.
6. YOU’RE NOT RESPONSIBLE FOR ISSUES OUTSIDE YOUR CONTROL
The entire point of Medicare Supplement guaranteed issue is to make sure that Medicare beneficiaries don’t lose access to valuable healthcare coverage for reasons that are beyond their control. In most cases, you can get a Medigap plan if you lose your coverage because of your insurer or your geographical location.
For instance, Medicare Advantage insurance providers can drop out of the Medicare network whenever they wish without penalty. This puts Medicare Advantage beneficiaries at risk because they don’t want to go without insurance coverage.
The same goes for an insurance company that stops offering your Medigap plan. Since that is outside your control, you don’t get penalized.
WHY SHOULD I CARE ABOUT MY GUARANTEED ISSUE RIGHTS?
Medicare Supplement guaranteed issue rights protect you from screening processes and waiting periods. Furthermore, they prevent you from being denied coverage by insurance companies.
Let’s say that you apply for a Medigap plan outside your initial enrollment period and without guaranteed issue rights. The insurer could deny coverage altogether or put you through a health screening to determine your risk to the insurance company.
You might wind up with no Medigap policy at all or with one that costs you much more than it would if you had Medicare Supplement guaranteed issue.
Medicare Supplement guaranteed issue isn’t something you should count on, but you do need to be aware of your rights. Should your insurer go out of business or stop offering your plan, you’ll want to know your options.
If you’re interested in applying for Medicare Supplement insurance, use Ensurem’s Medigap Quoter. It’ll provide you with quotes from a variety of insurance carriers that offer the Medigap plans in which you’re interested.