Medicare Supplement - Understanding Guaranteed Issue Periods

Every Medicare Supplement plan has specific guaranteed issue periods that allow for individuals to apply without being denied coverage, excluded by any pre-existing conditions, or changed because of health conditions that develop. These are all considered guaranteed issue rights that are federally mandated to make sure no one is excluded from coverage based on any of these conditions.

The times that these rights apply for you are usually when your existing health care coverage is changing or you are involuntarily losing coverage. Since Medigap plans are offered by privatized insurance agencies, they may generate specific guaranteed issue situations, but there are seven federally-mandated situations that every insurance company must abide by.

The first of the seven guaranteed issues is if your employer coverage pays after Medicare, in the form of a Medicare Supplement, and that coverage is ending. You may also be losing your Medicare Advantage service due to a number of reasons like moving away from the plan’s service area. Based on a guaranteed issue basis, you can also switch to a new policy if you are on a Medicare Select policy and you are moving out of the area of service. Another thing that could be completely out of your control is if your insurance company goes bankrupt.

Perhaps you were enrolled in PACE, but within a year of enrolling, you want to return to a Medicare Supplement . Also, if you switched from a Supplement plan to Medicare Advantage and within a year you want to switch back, this would be valid on a guaranteed issue basis. The final situation mandated by the federal government is if your insurance agency somehow misled you or did not follow the rules and you want to switch companies. This is valid for dropping either Medigap or Medicare Advantage.

If you fall into any one of these seven categories, you should be sure to sign up for coverage on a guaranteed issue basis. This will ensure your Medicare Supplemental Insurance will not change unexpectedly due to any of these reasons. In addition to individual companies being able to create their own guaranteed issue situations, states as a whole often do so as well.

Also understand that some situations have specific requirements for the plans that are available to you. This means you may fit into a guaranteed issue situation but you may have to enroll in a certain plan for it to apply.