What Are Medicare Supplement Guaranteed-Issue Rights?

Guaranteed-issue rights enable seniors to purchase Medicare Supplement coverage without any underwriting practices or health screenings by Medigap insurers.

Seniors have a guaranteed right if they experience a qualifying event, such as losing a job-based health insurance plan, moving to a new state and losing Medicare Advantage plan coverage, losing Medigap coverage due to an insurer’s insolvency, or turning 65 and enrolling in Original Medicare.

These rights give seniors the right to purchase any Medigap plan at the same rate as a healthy person in their age bracket.

Understanding Guaranteed Issue Rights for Medigap Policies

If you are considering a Medicare Supplement (Medigap) policy, understanding guaranteed issue rights is crucial.

These rights protect beneficiaries when their health coverage changes due to specific circumstances, ensuring they can obtain a Medigap policy without being denied or charged higher premiums based on their health.

What Are Guaranteed Issue Rights?

Guaranteed issue rights (also known as Medigap protections) ensure that insurance companies:

• Must sell you a Medigap policy regardless of your health status.
• Must cover all pre-existing health conditions immediately.
• Cannot charge higher premiums based on past or present health conditions.

These rights typically apply when other health coverage changes, such as losing existing insurance, switching from a Medicare Advantage plan, or other qualifying situations.

Additionally, individuals may have a “trial right” to try a Medicare Advantage Plan and switch back to Original Medicare with a guaranteed right to purchase a Medigap policy.

Common Guaranteed Issue Right Situations

Here are the most frequent circumstances under federal law in which you have a guaranteed issue right to purchase a Medigap policy:

Feature	Eligible Medigap Plans	Application Deadline
You have a Medicare Advantage Plan, and your plan leaves Medicare, stops serving your area, or you move out of the plan’s service area.	Medigap Plan A, B, C*, D*, F*, G*, K, or L available in your state.	60 days before coverage ends, up to 63 days after coverage ends.
You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) ending.	Medigap Plan A, B, C*, D*, F*, G*, K, or L available in your state.	Within 63 days of the latest of: coverage ending, notice received, or claim denial.
You have a Medicare SELECT policy and move out of its service area.	Medigap Plan A, B, C*, D*, F*, G*, K, or L available in your state or new state.	60 days before coverage ends, up to 63 days after coverage ends.
Trial Right: You joined a Medicare Advantage Plan or PACE when first eligible for Medicare and decide to switch back within one year.	Any Medigap policy sold in your state.	60 days before coverage ends, up to 63 days after coverage ends.
Trial Right: You dropped a Medigap policy to join a Medicare Advantage or SELECT plan for the first time, were enrolled less than a year, and want to switch back.	The Medigap policy you had before (if available) or Medigap Plan A, B, C*, D*, F*, G*, K, or L.	60 days before coverage ends, up to 63 days after coverage ends.
Your Medigap insurer goes bankrupt, or coverage ends through no fault of your own.	Medigap Plan A, B, C*, D*, F*, G*, K, or L available in your state.	Within 63 days of losing coverage.
You leave a Medicare Advantage Plan or Medigap policy due to misrepresentation or rule violations by the insurance provider.	Medigap Plan A, B, C*, D*, F*, G*, K, or L available in your state.	Within 63 days of coverage ending.

Note: Plans C and F are unavailable to new Medicare beneficiaries as of January 1, 2020. Those eligible for Medicare before this date may still purchase them.

State-Specific Rules and Additional Rights

While these are the federal guaranteed issue rights, some states provide additional protections. It’s always best to check with your State Insurance Department to understand your full range of options.

How to Apply for a Medigap Policy Using Guaranteed Issue Rights

If you qualify for a Medigap policy under guaranteed issue rights, follow these steps:

• Identify the Medigap plan you want based on availability in your state.
• Gather supporting documents, such as proof of coverage termination or plan changes.
• Apply within the required timeframe to ensure your guaranteed issue right is honored.
• Submit your application to the insurance company offering the Medigap policy you want.

Guaranteed issue rights protect Medicare beneficiaries from being denied essential supplemental coverage when facing changes in their health insurance.

Understanding these rights helps ensure you maintain comprehensive healthcare coverage without financial penalties or exclusions due to pre-existing conditions. If you believe you qualify for a guaranteed issue right, act promptly to secure your Medigap policy within the designated timeframes.

Which States Offer Guaranteed Issue Rights for Medigap?

Medicare Supplement Insurance (Medigap) is a crucial option for many seniors seeking to cover gaps in Original Medicare.

However, in most states, enrollees must go through medical underwriting if they apply for a Medigap plan outside of their initial enrollment period. This means they can be denied coverage or charged higher premiums based on pre-existing conditions.

However, a few states have special guaranteed issue rights that protect Medicare beneficiaries and ensure access to Medigap plans regardless of medical history.

States with Year-Round Guaranteed Issue for Medigap

The following states guarantee access to Medigap for all Medicare beneficiaries aged 65 and older, regardless of their health status:

• Connecticut – Medigap plans are available year-round with guaranteed issue rights.
• New York – Medigap plans are guaranteed year-round, ensuring all Medicare beneficiaries can enroll without medical underwriting.

States with Limited Guaranteed Issue Periods

Some states offer guaranteed issue rights for Medigap but with specific timeframes or conditions:

• Massachusetts – Medigap plans are guaranteed issue from February 1st through March 31st each year. This provides a limited window for beneficiaries to enroll without medical underwriting.
• Maine – Enrollees can switch to a different Medigap plan with the same or lesser benefits at any time during the year, offering flexibility for those looking to change their coverage.

Additional State-Specific Medigap Protections

Beyond the core guaranteed issue states, several others provide unique protections that allow Medigap enrollees to switch plans under certain conditions:

• Missouri – Offers an Anniversary Guaranteed Issue Period, enabling enrollees to switch to the same Medigap plan from a different carrier around their plan anniversary.
• Vermont – Some Medigap carriers offer year-round guaranteed issue rights, though this varies by insurance company.

Medigap Restrictions in Other States

In all other states and Washington, D.C., guaranteed issue rights for Medigap are limited. Medicare beneficiaries who switch from a Medicare Advantage plan back to Original Medicare may be denied a Medigap policy due to pre-existing conditions or face higher premiums if they apply outside of their initial Medigap Open Enrollment Period or a special enrollment period.

If you live in a state with guaranteed issue rights for Medigap, you have greater flexibility and protection when selecting or changing your Medicare Supplement coverage.

However, in most states, it’s essential to carefully consider your enrollment timing to avoid underwriting challenges. Understanding your state’s rules can help you make informed decisions and secure the best possible coverage for your healthcare needs.

What Is the Birthday Rule for Medicare Supplements?

The Birthday Rule for Medicare Supplement (Medigap) policies is a regulation that allows beneficiaries in certain states to switch their Medigap plan without medical underwriting around their birthday each year.

This means they can switch to another plan of equal or lesser benefits without worrying about health conditions affecting their eligibility or premium costs.

Key Points of the Birthday Rule:

• State-Specific: Not a federal rule—only available in certain states.
• Guaranteed Issue: Allows a switch to another Medigap policy with equal or lesser benefits without medical underwriting.
• Time Frame: Typically, beneficiaries have a limited window (e.g., 30-60 days) starting from their birthday to make a change.
• Plan Limitations: You cannot upgrade to a plan with more benefits; you can only switch to a similar or lower-benefit plan.

States That Have the Birthday Rule (as of recent updates):

• California – 60-day window
• Oregon – 60-day window
• Idaho – 63-day window
• Illinois – 45-day window (for those 65-75)
• Louisiana – 63-day window
• Nevada – 60-day window

Each state may have slight variations in the rule, so it’s always best to check with the state insurance department or a licensed agent.

What Is the Difference Between Open Enrollment and Medigap Guaranteed Issue?

The key difference between Medigap Open Enrollment and Medigap Guaranteed Issue lies in the timing, eligibility, and whether medical underwriting is required.

1. Medigap Open Enrollment

• This is a one-time, six-month window that starts when you are both 65 or older and enrolled in Medicare Part B.
• During this period, you can buy any Medigap plan available in your state without medical underwriting, meaning insurance companies cannot deny coverage or charge higher premiums due to pre-existing conditions.
• This is the best time to enroll in a Medigap plan because you get the lowest possible rate with the most plan choices.

2. Medigap Guaranteed Issue (GI) Rights

• These are special protections that allow you to buy a Medigap plan without medical underwriting but only in certain situations.
• Examples of situations that qualify for Guaranteed Issue rights:
  • You lose employer-sponsored coverage that was secondary to Medicare.
  • Your Medicare Advantage plan is leaving your area or shutting down.
  • You move out of your Medicare Advantage plan’s service area.
  • Your Medigap insurance company goes bankrupt or misleads you.
  • You joined a Medicare Advantage plan when first eligible but decide to switch back to Original Medicare within the first 12 months.
• Unlike Open Enrollment, GI rights limit your plan choices. In most states, insurers must only offer Medigap Plan A, B, C, F, K, or L (Plan F and C are only available if you were eligible for Medicare before 2020).
• You must apply within 63 days of losing coverage to use your GI rights.

Key Takeaways

Feature	Medigap Open Enrollment	Medigap Guaranteed Issue
Timing	6-month window when you are 65+ and enrolled in Part B	Specific qualifying events
Medical Underwriting	Not required	Not required
Plan Choices	Any Medigap plan available in your state	Limited to Plans A, B, C, F, K, or L in most states
Best Time to Enroll?	Yes. You get the best rates and all options	Only if you missed Open Enrollment and qualify for GI rights

If someone is eligible for both, Medigap Open Enrollment is the better option because of the broader plan selection and lower costs.

What Is the 6 Month Rule for Medigap Insurance?

The 6-month rule for Medigap insurance refers to the Medigap Open Enrollment Period (OEP). This is a one-time, six-month window that begins the first month you are both 65 or older and enrolled in Medicare Part B. During this period:

• You have guaranteed issue rights, meaning you can buy any Medigap (Medicare Supplement) plan available in your state without medical underwriting.
• Insurance companies cannot deny you coverage or charge higher premiums due to pre-existing conditions.
• After this period, if you apply for Medigap, insurers can medically underwrite your application, which may result in higher premiums or denial of coverage based on health status.

Some states have additional protections that extend beyond this period, but the standard federal rule is a one-time 6-month window for guaranteed issue rights when you first enroll in Medicare Part B.

Do Medicare Advantage Plans Have Guaranteed Issue Rights?

Medicare Advantage (MA) plans do not have the same guaranteed issue rights as Medigap (Medicare Supplement) plans.

However, there are specific times when you are guaranteed to enroll in a Medicare Advantage plan without being denied coverage due to health conditions.

When Do You Have Guaranteed Issue Rights for Medicare Advantage?

1. Initial Enrollment Period (IEP)

   • When you first become eligible for Medicare (turning 65 or qualifying due to disability).
   • You can enroll in an MA plan without any medical underwriting.

2. Annual Election Period (AEP) (Oct 15 – Dec 7)

   • You can switch from Original Medicare to a Medicare Advantage plan or change your existing MA plan.
   • No health questions or medical underwriting.

3. Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31)

   • If you are already in an MA plan, you can switch to another MA plan or go back to Original Medicare.
   • You cannot enroll in an MA plan if you are on Original Medicare.

4. Special Enrollment Periods (SEPs)

   • If you qualify for an SEP (such as moving out of the plan’s service area, losing employer coverage, or if your plan is discontinued), you can enroll in another MA plan without underwriting.

How Medicare Advantage Differs from Medigap in Terms of Guaranteed Issue Rights

• Medigap plans have guaranteed issue rights in specific situations, such as when you lose employer coverage, your MA plan is discontinued, or you’re in a trial period.
• Medicare Advantage plans accept all applicants during enrollment periods, but they can deny coverage outside of those periods (unless you qualify for an SEP).

If you want a Medicare Advantage plan, you generally need to enroll during the IEP, AEP, or an SEP to be guaranteed coverage.

Unlike Medigap, Medicare Advantage does not have ongoing guaranteed issue rights beyond these specific enrollment periods.

Bottom Line

Medigap Guaranteed-Issue Rights are an essential component of Medicare. When seniors experience a qualifying event, these rights provide options that prevent Medigap insurance companies from underwriting policies or charging more based on pre-existing conditions.

Seniors can use these rights to purchase any Medigap plan, even if they have pre-existing conditions. This means that seniors can rest easy knowing they will always have a Medigap plan available, ensuring they can access the healthcare services they need to lead healthy, happy lives.

Sources: Medicare.gov – KFF – HHS.gov – Medicare Interactive

FAQs

• What is the difference between open enrollment and guaranteed issues?

  The Medigap open enrollment period allows everyone to apply for Medicare Supplement without underwriting practices. Guaranteed-issue rights are only available during specific qualifying events, such as losing a job-based health insurance plan, moving to a new state, and losing Medicare Advantage plan coverage.

• Do I have to pay extra for the guaranteed issue?

  No, you do not have to pay extra for guaranteed issues. All seniors who meet the Medicare Supplement Guaranteed-Issue Right qualifications will be eligible to enroll in a Medigap plan at the same rate as a healthy person in their age bracket.