Smart Medicare Guaranteed Issue Rights Consumers. Federal & State Laws on "Medigap Protections". Reviewing GI Rights on Medicare.gov

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Guaranteed issue rights

Guaranteed Issue Rights (Also Called "Medigap Protections")

 are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:

• Must sell you a Medigap policy
• Must cover all your pre-existing health conditions
• Can't charge you more for a Medigap policy because of past or present health problems

In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a "trial right" to try a  

Medicare Advantage Plan (Part C)

 and still buy a Medigap policy if you change your mind.

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.

You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.

You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy's service area.

You joined a Medicare Advantage Plan or Program of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)

You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you.

Note
There may be times when more than one of the situations above applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice.

Can I buy a Medigap policy if I lose my health care coverage?

You may have a guaranteed issue right to buy a Medigap policy. Make sure you keep these items:

• A copy of any letters, notices, emails, and/or claim denials that have your name on them as proof of your coverage being terminated

• The postmarked envelope these papers come in as proof of when it was mailed

You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right.

If you have a Medicare Advantage Plan but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the plan. Ask that the new policy take effect no later than when your Medicare Advantage enrollment ends, so you’ll have continuous coverage.

Note
The guaranteed issue rights in this section are from federal law. These rights are for both Medigap and Medicare SELECT policies. Many states provide additional Medigap rights.

If you have questions or want to learn more about Medigap rights in your state:

• Call your State Health Insurance Assistance Program to make sure that you qualify for these guaranteed issue rights.

• Call your State Insurance Department if you’re denied Medigap coverage in any of these situations.