If you have Medigap guaranteed issue rights you can’t be denied coverage due to pre-existing conditions
The best time to buy a Medigap policy is during your Open Enrollment Period which begins on the first day you are both 65 and enrolled in Medicare Part B. Your Open Enrollment Period lasts for 6 months.
But what if you didn’t enroll during this period? Maybe you joined a Medicare Advantage plan and are unhappy with the coverage or maybe you stayed with your employer group coverage. You may be entitled to Medigap guaranteed issue rights. These Medigap protections allow you to buy a Medicare supplement even if you have a pre-existing condition.
Medigap guaranteed issue rights are generally available to you when your existing coverage changes in some way, such as losing your coverage. At other times you have a trial right related to your purchase of a Medicare Advantage plan.
If you are entitled to guaranteed issue rights an insurance company cannot refuse to sell you a Medigap policy. Depending on the circumstance that triggered your guaranteed issue right, you may be limited to which plans you can purchase.
You should not confuse guaranteed issue rights with your Medigap open enrollment period.
Times when you have Guaranteed Issue Rights
1. Your coverage is through a Medicare Advantage Plan and they are leaving Medicare, stopping service in your area or you move from the Plan’s service area. You should apply as early as 60 days prior to the plans end of coverage , but no later than 63 days after coverage has ended. Your Medigap policy can’t start until your Medicare Advantage coverage has ended.
2. If you have original Medicare and coverage from your employer or former employer (including COBRA and retiree benefits) and it is ending, you are entitled to Guaranteed Issue Rights. Apply for a Medigap policy no later than 63 days after your coverage ends or the date on the notice informing you of an end to coverage or the date on a claim denial if you were not previously informed.
3. You have a Medicare Select policy and you move out of the plans service area. Submit your application as early as 60 days prior to your coverage ending, but not later than 63 days after it ends.
4. (Trial Right) You joined a Medicare Advantage plan or PACE when you first became eligible for Part A, are within the first year of joining and want to switch to original Medicare. Submit an application up to 60 days prior to the date coverage will end but no later than 63 days after coverage ends.
5. (Trial Right) If you dropped a Medigap policy to enroll in a Medicare Advantage plan or switch to a Medicare Select plan for the first time and have been in the plan less than one year, you can switch back. Submit your application as early as 60 days prior to the date your coverage will end, but not later than 63 days after coverage ends.
6. You have guaranteed issue rights if your Medigap insurance company goes bankrupt or you lose coverage through no fault of your own. Submit an application within 63 days form the end of your coverage.
7. If you leave a Medicare Advantage plan or drop a Medigap policy because the company mislead you or didn’t follow the rules. Submit an application within 63 days from the date your coverage ends.
Important documentation you need to keep
You may have to prove that you are entitled to guaranteed issue rights. There are certain documents that you should keep to make your case that you qualify. Keep the following:
- A copy of any correspondence including; mailed letters and notices, emails or claim denials that include your name to show proof of coverage.
- Keep all postmarked envelopes for any notices or claim denial letters to show proof of the date correspondence was mailed.
Just in case you run into any red tape when exercising your Medigap guaranteed issue rights, you should submit your application prior to your coverage ending. Your new Medigap policy cannot start until your prior coverage ends. This may also allow you to avoid a lapse in health care coverage.