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Life Health > Health Insurance > Medicare Planning

FAQ: Guaranteed Issue for Medicare Supplement

By Staff Writer

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An agent from Tampa Bay, FL asks…

Q: When is the guaranteed issue period for Medicare Supplements?

A: There are many different guaranteed issue periods for Medicare supplement, because clients have a guaranteed issue right whenever they have other health care coverage that changes in some way. Beneficiaries also have “trial rights” so that they can try a Medicare Advantage plan, then switch to Medigap later if they change their mind.

The first time a Medicare beneficiary is guaranteed issue is during the Medigap open enrollment period, which lasts for 6 months and begins on the first day of the month in which the client is both older than 65 and is enrolled in Medicare Part B. A beneficiary may be able to buy a Medigap policy at other times, but the insurance company is allowed to deny a Medigap policy based on the client’s health. Also, in some cases it may be illegal for the insurance company to sell a Medigap policy (such as if the beneficiary already has Medicaid or a Medicare Advantage plan).

Additionally, it is important to remember that for open enrollment or guaranteed issue rights, the carrier cannot use medical underwriting. In most states, tobacco usage may be used to determine premiums even for open enrollment and guaranteed issue rights, but roughly 25 percent of the states require a carrier to issue at preferred/non-tobacco rates for open enrollment or guaranteed issue rights, regardless of actual tobacco usage.

The following are descriptions of seven other scenarios that may cause a client to qualify for guaranteed issue rights, including the timeline for each circumstance.

  1. A beneficiary is in a Medicare Advantage (MA) plan, and their plan is leaving Medicare, stops giving care in the beneficiary’s area, or if they move out of their plan’s coverage area. With this guaranteed issue right circumstance, a beneficiary can apply up to 60 calendar days before the date their health care coverage ends, and no later than 63 days after their coverage ends.
  2. The beneficiary has original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays, and this coverage had ended. The beneficiary must apply for a Medicare supplement policy no later than 63 calendar days after the latest day that the coverage ends, the date on the notice they get telling them that the coverage is ending, and the date on the claim denial (if this is the only way they know that their coverage has ended).
  3. The client has original Medicare and a Medicare SELECT policy, and they move out of the Medicare SELECT policy’s area. The beneficiary can keep their Medicare supplement policy, or move to another MedSupp policy. If they choose to move, they can apply up to 60 calendar days before, but no later than 63 days after, the date their health care coverage ends.
  4. If a beneficiary joined an MA plan or PACE when they were first eligible at age 65, and within the first year of joining they decide they want to switch to original Medicare, they can apply for a Medigap policy up to 60 days before but no later than 63 days after their coverage ends.
  5. A client previously dropped a MedSupp policy to join an MA plan or to switch to a Medicare SELECT policy for the first time, and they have been in the plan for less than a year but they decide they want to switch back. They can apply up to 60 calendar days before but no later than 63 days after their coverage ends.
  6. The customer’s Medigap insurance company goes bankrupt and the client loses their coverage, or if the Medigap policy coverage ends through no fault of the beneficiary. They must apply no later than 63 days after their coverage ends.
  7. If a beneficiary leaves an MA plan or drops a Medigap policy because the company didn’t follow the rules or because the company misled the beneficiary, the client must apply no later than 63 days after their coverage ends.

For more information on Medicare supplement and guaranteed issue, see the 2010 “Choosing a Medigap” guide.

Tim Fields, an agent from Maryland, assisted ASJ in compiling this answer.

If you would like to be considered for our Medicare FAQ expert panel to answer frequently asked questions, email associate editor Heather Trese.

Do you have a Medicare question that you would like answered? Email us and let us know! Please put “Medicare FAQ” in the subject line.

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