For millions of Americans, supplementing their Original Medicare benefits with a Medigap policy in order to fill in the gaps left by Medicare is a necessity. A Medicare Supplement plan pays for coinsurance, copayments, and some of the deductibles that Original Medicare insurance does not cover. It also provides extended benefits in many cases.
You can enroll in a Medicare Supplement, also known as Medigap, plan during your initial enrollment period. This period begins the month you turn 65 and enrolled in Medicare Part B. During this initial six-month enrollment period, you have a guaranteed issue right to purchase any Medigap policy sold in your state. At this time, private insurance companies are required to accept you and to offer a policy at their best available rate. Your health status, past or present, is not taken into consideration during your initial enrollment period, and you cannot be refused coverage.
However, if you wish to purchase a Medigap policy at any time outside your initial enrollment period, you may be subject to medical underwriting, or an application based on a health examination and your medical history. You also risk being rejected or having to pay a higher premium.
Understanding Guaranteed Issue Rights
Private insurance companies are lawfully obligated to sell you a Medicare Supplement policy if you enroll during your initial enrollment period you qualify for guaranteed issue rights
Guaranteed issue rights are also known as Medigap protections. If you qualify, a private insurance company must abide by government regulations to give you access to certain Medicare Supplement plans, it must offer coverage for all pre-existing health conditions, and it cannot charge you a higher premium for the insurance plan due to health problems, either in the past or present.
Here is a list of some situations that may provide you with guaranteed issue rights to purchase a Medigap plan if you meet specific criteria:
• You have another form of health coverage that is changing or that you are going to lose within a short period of time.
• You have a Medicare Advantage (Part C) plan that is leaving Medicare or is ending its coverage in your area. This is also true if you are moving out of your plan’s service area.
• You are covered by Original Medicare Parts A and B as well as a group health plan provided by your employer or union that is ending. This is true if the group plan has been offering extended coverage after Original Medicare coverage ends.
• You are covered by Original Medicare Parts A and B and Medicare SELECT but you are leaving your coverage area for Medicare SELECT.
• You have a Medicare Advantage (Part C) plan but are switching back to Original Medicare.
• You initially had a supplement plan but now have a Medicare Advantage plan (and have had it for less than one year), and you wish to change back to a Medicare Supplement plan.
• Your private insurance provider goes bankrupt or your policy ends in a way that is not your fault.
• Your private insurance provider has been misleading or fraudulent and you decide to cancel your plan because of this.
In some cases, if you are in your “trial right” period for a Medicare Advantage (Part C) plan, which is up to 12 months after initial enrollment, you also have guaranteed issue rights to purchase a private supplemental health insurance plan during this special enrollment period. Federal law allows 63 days of guaranteed issue rights after you disenroll from your Medicare Advantage plan, giving you time to enroll in a Medicare supplement plan.
If you are uncertain about your eligibility to purchase a supplement plan or would like to learn more about guaranteed issue rights, you can discuss your specific needs with a licensed agent.