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When you apply for a Medigap policy (Medicare supplemental insurance), you have certain rights, which, by Federal law, can protect you from being denied coverage. If you already have a policy, you also have rights to protect you from having to keep a plan that is not right for you. These rights are called Medigap protections, or guaranteed issue rights.
Guaranteed issue rights
During your six-month Medigap open enrollment period, you have the right to buy any Medigap policy offered in your state. Although this is the best time to purchase a Medigap policy, there are also a few situations outside the open enrollment period in which you may still have a guaranteed right to buy a Medigap policy if you're 65 or older.
In general, you qualify for a guaranteed issue right when you have other health care coverage that changes in some way, such as when you lose the coverage for any reason that is not your fault. In these situations, an insurance company must sell you a Medigap policy and cover all your pre-existing health conditions. The company cannot charge you more for a Medigap policy despite past or current health problems.
You qualify for guaranteed issue rights under the following situations:
| Your situation | What plans you can buy |
You're in a Medicare Advantage Plan, and:
|
Medigap Plan A, B, C, F, K, or L
|
You have Original Medicare (Part A and Part B) and a group health plan (including retiree or COBRA coverage), and:
|
Medigap Plan A, B, C, F, K, or L
|
You have Original Medicare and a Medicare SELECT policy, and:
|
Medigap Plan A, B, C, F, K, or L
|
You have a Medigap policy, and:
|
Medigap Plan A, B, C, F, K, or L |
You leave your Medicare Advantage Plan or cancel your Medigap policy because:
|
Medigap Plan A, B, C, F, K, or L |
Guaranteed issue trial rights
Another type of right is called a trial right, which allows you buy or switch back to a Medigap policy within the first year of either joining a Medicare Advantage Plan or buying a Medicare SELECT policy.
You qualify for guaranteed issue trial rights under the following situations:
| Your situation | What plans you can buy |
You joined a Medicare Advantage Plan when you were first eligible for Medicare Part A at 65, and:
|
Any Medigap plan sold in your state |
You dropped a Medigap policy to buy a Medicare SELECT policy or to join a Medicare Advantage Plan for the first time, and:
|
The same Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy
|
How to prove you have a guaranteed issue right
In order to prove you have a guaranteed issue right, you may need to send a copy of the following documents with your Medigap application:
- Any letters, notices, e-mails, and/or claim denials that have your name on them to prove that your coverage is being terminated
- The postmarked envelope these papers come in to prove when they were mailed to you
Keep in mind that certain states may have additional consumer protections and rights over and above Federal law, so check with your State Insurance Department for details.
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