Know Your Guaranteed Issue Rights for Medigap

Medigap Medicare guaranteed issue rights insurance

What is Medigap?

Medigap is simply supplemental insurance that works alongside Medicare as a secondary payer on expenses Medicare doesn’t cover. Medigap encompasses various private health insurance plans which provide help with some copays, coinsurance, and deductibles for Medicare-covered charges.

To enroll in a Medigap plan, you must already be enrolled in Medicare Part A and Medicare Part B. You can buy a Medigap plan when you are first eligible for Medicare, starting the month you turn 65 and six months thereafter.

Guaranteed issue periods

There are also some guaranteed issue periods, where you are guaranteed the right to purchase a Medigap plan, for which the insurer must cover preexisting conditions and can’t charge you more because of past or present health problems. These guaranteed issue rights occur if:

  • You’re in a Medicare Advantage plan which is leaving Medicare, stops giving care in your area, or you move out of its service area.
  • You have Original Medicare and a supplemental insurance plan from your employer or union, and that plan is ending.
  • You have Original Medicare and a Medicare SELECT policy, and you move out of the SELECT policy’s service area.
  • You joined a Medicare Advantage Plan or PACE at age 65, and within the first year you decide to switch to Original Medicare (this is called a trial right).
  • You dropped a Medigap policy to join a Medicare Advantage Plan for the first time. You have been in the plan for less than one year and want to switch back (also called a trial right).
  • You lose coverage from your Medigap insurance company because it goes bankrupt or for another reason that is no fault of your own.
  • You leave a Medicare Advantage Plan or drop a Medigap policy because of the insurer’s misleading behavior or not following the rules.

Restrictions

There are restrictions for all of these scenarios – usually you have to enroll in a Medigap plan within 63 days of losing other coverage. Make sure to keep copies of letters with your name on them and postmarked envelopes proving that you lost other coverage on a certain date. You may need to send these in with your Medigap application.

Many states offer more Medigap rights. Check with your local SHIP or your State Insurance Department.

Note also that you can’t be enrolled in both Medigap and Medicare Advantage (Medicare Part C) at the same time.

Related Links

VIDEO: Medicare Advantage vs Medigap

Navigating the Medigap Highway

Medigap vs. Medicare Advantage: How to Choose

Medicare Advantage and Medigap: What’s the Difference?

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