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. You usually have 123 days to do so (60 days before your current plan expires and 63 days after).

The following are the seven ways to obtain Medigap without having to endure a waiting period or health screening.

1) Employer-Sponsored Retiree Plan Ends

You will be able to enroll in a Medigap plan if your employer-sponsored retiree plan that supplements Medicare ends. Note this does not apply if your plan provided primary benefits or if you stopped paying your premium.

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:

  • If your employee-sponsored retiree plan continues to offer benefits but ends your supplemental coverage
  • If you lose eligibility due to divorce or death of primary member
  • If your employee-sponsored retiree plan no longer pays Medicare Part B coinsurance

3) Benefit Change or Termination of Your Medicare Advantage Plan

If your Medicare Advantage plan increased your premium or copayments by 15% or more, reduced your benefits, stopped offering the plan, or ends its relationship with your provider, then you have a right to buy a Medigap Plan BUT only from the same Medicare Advantage company (either organization, network, or organization). If the company does not sell Medigap Plans you can purchase from another company.

It is important to note than 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.

5) Medicare Finds that a Health Plan Commits Fraud, Etc.

You may enroll in Medigap with guaranteed issuance if your health plan, contracted through Medicare, does one of the following:

  • Health plan commits fraud
  • Health plan loses its contract with Medicare
  • Health plan mislead you when you enrolled
  • Health plan does not meet its Medicare contractual obligations

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 a Medigap plan 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 another health plan contracted with Medicare, but decide within the first 12 months that you want to go back to your previous Medigap plan, you can. If your original plan is not available, at that time, and only in this case, you can choose any available Medigap Plan and from any provider. However, if you were originally with MA or PACE then switched to Medigap then back to MA or PACE (I know it makes your head spin) you cannot switch back to Medigap.

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.

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