Medicare Supplement guaranteed issue rights allow beneficiaries the rare opportunity to enroll in a Medicare Supplement (Medigap) plan without answering underwriting health questions. When you are eligible for guaranteed issue rights, it is crucial to enroll in a plan before you no longer have these rights.
Once you miss your window of opportunity, you must answer underwriting health questions to enroll in a Medigap plan. If you have pre-existing conditions, this could result in denial of your application.
What are Guaranteed Issue Rights For Medicare Supplements?
When you are applying for a Medicare Supplement plan, there are only two times when you will not be required to answer medical underwriting health questions. The first is during your Open Enrollment Period when you are first eligible for Medicare, and the second is when using guaranteed issue rights.
Medicare Supplement guaranteed issue rights are a unique set of protections given to qualifying Medicare beneficiaries for a specific amount of time based on their qualifying event. When you are granted guaranteed issue rights, a Medicare Supplement insurance company cannot deny you acceptance to certain Medigap plans.
Scenarios That Grant Guaranteed Issue Rights For Medicare Supplements
There are seven unique scenarios that will grant a Medicare beneficiary eligibility to use guaranteed issue rights.
These include:
- Your Medicare Advantage Plan stops covering services in your area or you move out of the service area of your Medicare Advantage plan
- You have Original Medicare and employer group coverage (including COBRA) that is secondary to Medicare and is ending
- You move out of your Medicare SELECT policy service area
- Your Medigap insurance company goes bankrupt or ends your coverage through no fault of your own
- You leave a Medicare Advantage or Medigap plan because the company misled you
- Trial Right 1: You joined a Medicare Advantage Plan when you were first eligible for Medicare at age 65 and within the first 12 months wish to switch to Original Medicare
- Trial Right 2: You dropped a Medicare Supplement plan to join a Medicare Advantage plan for the first time and you want to switch back to Original Medicare
If you experience any of the above scenarios, you might be eligible for Medicare guaranteed issue rights. It is important to speak with a licensed agent to ensure you are getting the most out of your Medicare Supplement guaranteed issue rights.
Documents Required For Medicare Supplement Guaranteed Issue Rights
If you are using guaranteed issue rights to enroll in a Medicare Supplement, there are certain documents that the Medigap carrier you are enrolling with will require you to provide.
If you are leaving a Medicare Advantage plan, you will be required to show a dis-enrollment letter from your Medicare Advantage plan carrier. This letter must include your name and the date your coverage ends.
If you are using one of the two Medicare Trial Rights, you must prove your eligibility by providing documents from your previous Medicare Supplement plan, or documentation stating you enrolled in a Medicare Advantage plan less than 12 months ago and are new to Medicare. These documents can include proof of Medigap payment and ID cards with your current plan information.
Each carrier has slightly different requirements regarding what documents you must provide when using guaranteed issue rights. However, requirements will be communicated during the application process.
Involuntary vs. Voluntary Loss Of Coverage
Involuntary loss of coverage means that your insurance company is dropping your coverage through no fault of your own. This means that you are not responsible for the loss of coverage. When you involuntarily lose coverage that is paying secondary to Original Medicare, you automatically qualify for guaranteed issue rights.
Voluntary loss of coverage means that you are choosing to drop your insurance coverage with your current carrier. If you are leaving group coverage or COBRA coverage that is paying secondary to Medicare, your eligibility for guaranteed issue rights varies by state.
Further, if you lose Medicaid coverage due to an increase in income, you may not receive guaranteed issue rights for Medicare Supplement plans. Loss of Medicaid eligibility varies by state.
Which Medicare Supplements Use Guaranteed Issue Rights?
The Medicare Supplement plan you can enroll in using guaranteed issue rights depends on the date your Original Medicare began. If your Medicare Part A or Medicare Part B began before January 1, 2020, you are only eligible to use guaranteed issue rights on Medigap Plan F or Medigap Plan C.
If you received Original Medicare after January 1, 2020, you are eligible to use guaranteed issue rights for any Medicare Supplement plan expect for Medigap Plan F or Medigap Plan C.
However, regardless of your Medicare enrollment date, if you utilize Trial Right 2, you must enroll in the same exact plan and carrier you previously enrolled with. If the plan is no longer available, you may enroll in any plan based on your Medicare enrollment date.
