Medicare’s Guaranteed Issue Rights

Outside of your Medigap Open Enrollment Period, you will always have to answer health questions to qualify for a plan during your Medicare Supplement enrollment. That is unless you have one of the seven Medicare rights called Guaranteed Issue (GI) rights as determined by Medicare.

These seven rights, detailed below, allow you to enroll into a Medicare Supplement plan without having to answer health questions. Following enrollment, the insurance carrier must cover any pre-existing conditions and cannot charge you more for the plan regardless of any past or present health issues.

Below are the most basic details about GI rights:

GI Rights Caused by Medicare Changes In Coverage

  1. You have a Medicare Advantage program which leaves Medicare, leaves your area, or you are moving out of the plan’s service area. If this applies to you, pay very close attention to your timeline as you have specific limits to how long you may use this GI right.
  2. You have Original Medicare and an employer-sponsored insurance and the employer-sponsored plan is ending. This could be caused by retirement, the employer discontinuing benefits, COBRA ending, etc.
  3. You have Original Medicare and a Medicare SELECT plan and are moving out of the Medicare SELECT plan’s service area. Just as is with GI Right #1, pay attention to your timeline if this fits your situation.
  4. Your Medigap insurance company goes bankrupt or your Medigap plans because of something out of your control. An extremely rare occurrence, this provides added protection to you as a Medicare beneficiary.
  5. You drop a Medicare Advantage or Medigap policy because “the company hasn’t followed the rules, or it misled you.” Keep in mind that you must go through an appeal process to obtain this GI right so it is best to speak with an industry expert prior to dropping your current coverage.

Trial Rights

  1. You have a Medicare Advantage plan which you obtained at age 65 and, prior to turning 66, you want to switch back Original Medicare. Again, pay attention to your timeline with this GI right.
  2. You dropped a Medigap plan for a Medicare Advantage plan for the first time, have been in the Medicare Advantage plan for less than a year, and would like to switch back. The key here is that you must switch back to the Medigap plan you originally had if it is still being offered.

Guaranteed Issue Rights Basics

 

As you may have noticed, there are several timelines and plan restrictions that may pop up depending on your specific situation. If you think you may have a Guaranteed Issue right, feel free to call one of our licensed agents to learn more about your options (866-572-4036).