MEDICARE SUPPLEMENT: HOW YOU MIGHT QUALIFY FOR GUARANTEED ISSUE
Medicare Supplement guaranteed issue rights can prove difficult to understand, especially since the criteria depends on your specific circumstances. Maybe you are approaching age 65 and want to know your options, or perhaps you’ve lost your healthcare insurance and you need to remedy the situation.
Regardless, Medicare Supplement guaranteed issue — also called Medigap protections — helps protect your rights and ensure you get health insurance at the best possible rate. Let’s examine Medicare Supplement guaranteed issue and determine whether you qualify for it.
WHAT IS MEDICARE SUPPLEMENT GUARANTEED ISSUE?
A Medicare Supplement — also called Medicare supplemental insurance or Medigap — covers certain healthcare expenses that Original Medicare Parts A and B won’t cover. The three most common expenses include deductibles, copayments, and coinsurance.
As you can see from the chart above, each of the 10 Medigap plans covers different types of expenses related to healthcare. For instance, Medigap Plans C and F cover your Original Medicare Part B deductible. Some plans cover 100 percent of your skilled nursing facility coinsurance, while others pay for 50 or 75 percent.
Guaranteed issue rights can come into play if you don’t sign up for a Medicare Supplement during your Initial Enrollment Period (IEP) or if you fit any of the other criteria. If you qualify for Medicare Supplement guaranteed issue, the same rules apply that did during your IEP.
Medicare supplemental insurance guaranteed issue rights allow you to apply for any Medigap plan that’s offered in your area. You can choose from any private insurance company that offers that plan in your zip code, and the insurer must offer you its best rate for that plan.
Insurance companies can’t subject you to underwriting if you have Medicare Supplement guaranteed issue. In other words, they can’t increase your premium based on pre-existing conditions or chronic diseases. They can only consider where you live and your tobacco use.
On the other hand, if you apply for Medigap plans outside your IEP and without guaranteed issue rights, the insurance company can deny your application or charge you a higher premium. They can also refuse to cover pre-existing conditions at that point.
WHAT ARE THE CRITERIA FOR MEDICARE SUPPLEMENTAL INSURANCE GUARANTEED ISSUE RIGHTS?
There are several circumstances in which you might qualify for Medicare Supplement guaranteed issue rights. First, we’ll cover situational circumstances that allow you to apply for Medigap plans without any penalties.
For instance, let’s say you already have a Medicare Supplement, but your insurance company goes out of business or you discover that your insurer has not followed Original Medicare rules. Either of those two circumstances would qualify you for guaranteed issue rights.
Similarly, you might qualify for Medicare Supplement guaranteed issue rights if you have a Medicare Advantage plan — also known as Medicare Part C — and you no longer have access to it. The company might discontinue the plan, you might move out of the service area, or the insurer might leave Medicare.
Many people work after they become eligible for Medicare Parts A and B. If you have Original Medicare Part A as well as group health coverage, you have guaranteed issue rights as soon as the group coverage ends. The same is true if you have Original Medicare as well as a Medicare SELECT plan, and you move out of the plan’s geographical coverage area.
WHAT IS A TRIAL RIGHT?
You can also qualify for guaranteed issue based on trial rights. Medicare supplemental insurance becomes available to you based on protections from Original Medicare that allow you to “try out” certain healthcare options before you decide they’re right for you permanently.
If you signed up for a Medicare Advantage plan during your IEP, then decided to switch to a Medigap plan during the first 12 months, you have Medicare Supplement guaranteed issue rights. The same applies to beneficiaries of Medigap plans who dropped coverage to switch to a Medicare SELECT plan or Medicare Advantage plan, then decided to switch back within 12 months.
CAN YOU CHOOSE FROM ALL MEDIGAP PLANS?
Certain guaranteed issue rights have restrictions. For instance, if you’re switching back to Medicare supplemental insurance after trying Medicare SELECT or Medicare Advantage, you must return to the same policy letter you had in the first place as long as it’s still available.
You’re also limited if you’re applying for Medigap plans after you employer group coverage ends. Medicare only allows you to apply for Medigap Plans A, B, C, F, K, or L. The same is true if you move out of your Medicare SELECT policy’s coverage area and become eligible for Medigap.
Keep in mind that Medigap Plans C and F will disappear after 2020. Even if you qualify for guaranteed issue rights, you will not be able to apply for those plans following that date. However, if you become eligible before 2020, you can apply for Plans C and F as long as you’re entitled to under Medicare rules.
Medicare Supplement guaranteed issue rights can help you better manage your healthcare and budget. If you qualify for these rights, you get a new chance to apply for Medigap plans and enjoy their enhanced coverage levels.
Medigap plans enable you to budget more effectively for unexpected healthcare expenses. They also bring peace of mind.
Choosing the right Medigap plan for your specific needs, however, remains essential. There are several Medicare Supplement plans available from which to choose, so research each one carefully before you make your decision. Use Ensurem’s Medigap Quoter to get fast, accurate quotes on all Medigap plans available in your area. You’ll see how much you’ll pay in premiums for each insurance company so you get the best possible price.