Guaranteed Issue Rights
Guaranteed issue rights, also called Medigap protections, are your rights to purchase Medigap policies when you are not in your Medigap open enrollment period. These rights prevent insurance companies from denying you a Medigap policy or put conditions on buying one in certain situations.
What Are Guaranteed Issue Rights?
Your guaranteed issue rights under Medicare means that insurance companies have to offer you their Medigap coverage when you are Medicare eligible and your health coverage changes in some major or significant way.
- Insurers that sell Medigap policies must sell you a Medigap policy.
- The insurer must cover all your preexisting health conditions.
- The insurer cannot charge you more for a Medigap policy based on past or current health conditions.
These Medigap protections come into play outside the Medigap open enrollment period — the six-month period that begins once you are 65 or older and enrolled in Medicare Part B.
When You Have Guaranteed Issue Rights
There are seven situations in which you have guaranteed issue rights. In addition to changes in your health coverage, they include your trial rights — effectively your right to “test drive” a Medicare Advantage plan and still buy a Medigap policy if you change your mind.
- Medicare Advantage Plan Ends
- If your Medicare Advantage plan leaves Medicare or you move outside its coverage area, you can switch to Original Medicare and purchase a Medigap policy. You can make the change between 60 days before your Medicare Advantage coverage ends but no later than 63 days after it ends.
- Group Health Plan Ends
- If you have Original Medicare and union or employer group health coverage that is ending, you can buy a Medigap policy. You must make the purchase no later than the latest date of three situations: The date your coverage ends, the date you get a notice that the coverage is ending or the date on a claim denial if that’s the only way you were notified your coverage ended.
- Moving out of a Medicare SELECT Coverage Area
- You can buy a Medigap policy as early as 60 days before Medicare SELECT coverage ends but no later than 63 days after it ends.
- Medigap Insurer Goes out of Business
- If the company that issued the Medigap plan goes bankrupt, or the coverage ends through no fault of your own, you can purchase a Medigap policy sold by any insurance company in your state. But you must purchase it within 63 days of the date coverage ends.
- Medigap Insurer Breaks the Rules
- If a company violates rules or regulations or if it misleads you, you can drop a Medigap or Medicare Advantage plan. You can purchase certain Medigap plans sold in your state by any insurance company, but you have to purchase it no later than 63 days after the date your coverage ends.
- Enrollment Trial Rights
- You get a 12-month trial of Medicare Advantage when you enroll into Medicare for the first time upon becoming eligible for the first time at age 65. Within the first year of joining, you can decide to switch to Original Medicare.
- Medigap Policy Trial Rights
- If you switch from Medigap coverage to a Medicare Advantage plan and want to change back, you can purchase your previous policy — if it’s still available. If it isn’t, you can purchase a Medigap policy from any insurer in your state. But you have to do so within 63 days of when your Medicare Advantage coverage ends.
In most states, there are 10 standardized Medigap plans. Under your guaranteed issue rights, you may be able to choose from only some of these Medicare plans in certain situations.
If more than one situation applies to you, you have the right to choose the situation that gives you the best choices and options to replace your coverage.
These guaranteed issue rights are federal law, but your state may provide more Medigap and Medicare SELECT rights. You can contact your State Health Insurance Assistance Program to find out your rights in your state.
Can You Buy Medigap Without Guaranteed Issue Rights?
If you don’t meet any of the situations for guaranteed issue rights to take effect, you may still be able to buy a Medigap policy after your Medigap open enrollment period ends.
If you have preexisting conditions, insurers can refuse to sell you a Medigap policy or charge you higher premiums. They can also require a six-month waiting period before covering your preexisting condition.
An insurer may also require you to pass medical underwriting exams before deciding to sell you a Medigap policy.
During this process, the insurer can examine your past and current medical records to check for chronic or serious medical conditions such as heart disease, cancer and diabetes risks. The insurer can use this information to deny you a Medigap policy.
4 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, February). Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. Retrieved from https://www.medicare.gov/sites/default/files/2022-03/02110-medigap-guide-health-insurance.pdf
- U.S. Centers for Medicare & Medicaid Services. (2004, March). Medigap Guaranteed Issue Requirements in Situations Involving Termination of Group Health Plan Coverage Because the Employee Retires. Retrieved from https://www.cms.gov/medicare/health-plans/medigap/downloads/mdgp0401.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Guaranteed Issue Rights. Retrieved from https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights
- U.S. Centers for Medicare & Medicaid Services. (n.d.). When Can I Buy Medigap? Retrieved from https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap