If you miss your Initial Enrollment and have a health condition, don’t worry. You may qualify for Medigap Guaranteed Issuance. Read all about it here.
Medigap plans are supplemental insurance plans that work alongside Original Medicare. Most people know there is a Medigap Initial Enrollment period that begins when you are first eligible for Medicare, but you also have guaranteed issuance if you enroll during a Medigap Special Enrollment Period. In most situations you can apply up to 63 days after your current coverage ends, and in many (such as a Medicare Advantage plan ending or the trial right) you can also apply as early as 60 days before it ends.
The following are seven ways to obtain Medigap without having to endure a waiting period or health screening. In most of these federal situations you are guaranteed Plans A, B, C, F, K, or L (or Plans A, B, D, G, K, or L if you were new to Medicare on or after January 1, 2020); exceptions are noted below. There are many additional options not on this list so please check out our state-specific and other guaranteed approval situations for switching Medicare insurance not listed here. (Source: Medicare.gov)
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1) Employer-Sponsored Retiree Plan Ends
You will be able to enroll in a Medigap plan if your employer or union group health plan (including retiree or COBRA coverage) that pays after Medicare is ending. You must apply no later than 63 days after the latest of: the date the coverage ends, the date on the notice you receive, or the date a claim is denied because the coverage ended. Note this does not apply if your plan paid primary (before Medicare).
California allows for 2 more ways to enroll in Medigap after your initial enrollment period.
2) Reduction of Benefits or Loss of Eligibility of Employer Plan
You are able to get Medigap with guaranteed issuance if your employer or union plan that pays after Medicare stops covering you, for example:
- the employer-sponsored plan that supplements Medicare terminates
- your employer-sponsored retiree plan continues to offer benefits but ends your supplemental coverage
- you lose eligibility due to divorce or the death of the primary member
- your employer-sponsored retiree plan no longer pays Medicare Part B coinsurance
Voluntarily dropping your employer coverage does not create a federal guaranteed issue right, although some states offer extra protections.
3) Your Medicare Advantage Plan Leaves Medicare or Your Area
If your Medicare Advantage plan is leaving Medicare, stops giving care in your area, or isn’t renewing its contract, you can buy a Medigap Plan from any company that sells the guaranteed plans in your state. You can apply as early as 60 days before your Medicare Advantage coverage ends and no later than 63 days after it ends.
California only: If your California Medicare Advantage plan increases your premium or copayments by 15% or more, reduces your benefits, or ends its contract with a provider who is currently treating you (except for quality-of-care reasons), California law gives you a right to buy a Medigap plan from the same company. If that company does not sell Medigap plans, you can purchase from another company. Learn more about this California rule.
It is important to note that an MA plan may at anytime discontinue its contract with a provider.
4) Moving Out of a Medicare Part C Area of Coverage
If you move out of the area of your Medicare Advantage (MA) plan or Program for All-Inclusive Care for the Elderly (PACE) organization you can enroll in Medigap. You can do this even if an MA plan or PACE organization are available in your new area. The same right applies if you have a Medigap SELECT policy and move out of its service area.
5) Your Plan Commits Fraud, Misleads You, or Goes Bankrupt
You may enroll in Medigap with guaranteed issuance if your Medicare Advantage plan or Medigap policy does one of the following:
- Health plan commits fraud
- Health plan loses its contract with Medicare
- Health plan misleads you when you enrolled
- Health plan does not meet its Medicare contractual obligations
- Your Medigap insurance company goes bankrupt or your Medigap coverage ends through no fault of your own
You must apply no later than 63 days after your coverage ends.
6) Medicare Trial Period
If you joined a Medicare Advantage plan or PACE organization when you first became eligible for Medicare at 65, you may switch to Original Medicare and buy any Medigap plan sold in your state within the first 12 months of enrollment with guaranteed issuance.
However, if you were previously in either a MA or PACE and already switched, you would not be eligible for the guaranteed issuance.
7) Medicare Trial Period: Take Two
If you switch from a Medigap plan to a Medicare Advantage plan for the first time, but decide within the first 12 months of your MA plan that you want to go back to your previous Medigap plan, you can. You must go back to the same Medigap plan you had before, with the same company, if it’s still available. If your original plan is not available, you can choose Plan A, B, C, F, K, or L (or Plan A, B, D, G, K, or L if you were new to Medicare on or after January 1, 2020) from any provider that sells it in your state.
If your case doesn’t fit into any of these categories, don’t worry—you may still be eligible for a Medigap plan. Before you even think about applying for a Medigap plan, use our Instant Medigap Underwriting Checker. It’s a breakthrough tool that predicts whether your application is likely to be accepted.
For help with switching into a Medigap plan with guaranteed issuance during your Special Enrollment Period or joining a plan at any other time call the number above or click here if you’re ready to get a Medigap instant quote.