2022 Guaranteed Issue Period

As a Medicare beneficiary, you have certain rights when it comes to coverage. “Why is it important to know these?” you may ask. Read further to see why this makes such a big difference when thinking about Medicare enrollments.

Insurance companies can make determinations on whether they will approve or deny your application. This is based off an evaluation of your current health conditions through a process called medical underwriting. There are only two circumstances of when you do not have to go through the Underwriting process. One is if you have guaranteed issued rights. The other is if you qualify for the Medicare Supplement Open Enrollment Period, click here to read if this applies to you.

What is a Guaranteed Issue Right?

Also called “Medigap Protections,” a guaranteed issue right means that an insurance company cannot deny you coverage based off any pre-existing health conditions. Other important factors to know are that an insurer must sell you a Medicare Supplement policy. They also cannot charge you more based off your past or present health conditions, and the policy’s coverage does not change just because you have a guaranteed issue right. It will be the same coverage as issued to someone who must go through Underwriting. Also know that the insurance company must cover all your preexisting health conditions.

How Can I Qualify for Guaranteed Issue Rights?

It is important to know the qualifying factors of a guaranteed issued plan for many reasons. You will want to communicate your situation to a trusted insurance source that knows the market and Medicare rules. It is also important to know the factors because each have a different timeframe for enrollment. If you miss the timeframe, you will have to go through Underwriting if trying to obtain a Medicare Supplement policy.

Medicare Supplement Guaranteed Issue Right Situations

Here are the seven circumstances of when you qualify for a guaranteed issued right:

1. Your Medicare Advantage Plan Ends

If you move outside your Medicare Advantage service area, or if your Medicare Advantage plan leaves Medicare, you can move back to Original Medicare and purchase a Medicare Supplement Plan A, B, C, D, F, G, K, or L (Plans C and F are only available to those eligible for Medicare prior to 2020).  

Timeframe: Enrollment in a Medicare Supplement plan must be done as early as 60 days before the date your coverage ends, but no later than 63 days after coverage ends.

2. Your Group Health Plan Ends

If your union or group coverage (including retiree or COBRA) is coming to an end, you are eligible for a guaranteed issue right when purchasing a Medicare Supplement Plan A, B, C, D, F, G, K, or L (Plans C and F are only available to those eligible for Medicare prior to 2020).  

Timeframe: You must purchase a Medicare Supplement no later than the date your coverage ends, the date you get a notice, or the date on a claim denial - if that was the only way you were notified that your coverage ended.

3. You Move from Your Medicare SELECT Coverage Area

You may purchase a Medicare Supplement Plan A, B, C, D, F, G, K, or L (Plans C and F are only available to those eligible for Medicare prior to 2020). 

Timeframe: You must enroll as early as 63 days before the date your coverage will end, and no later than 63 days after your coverage ends.

4. Your Current Medicare Supplement Insurer Goes Out of Business

If your Medicare Supplement insurer goes out of business or coverage ends because of no fault of your own, then you are guaranteed issue eligible and may purchase a Medicare Supplement Plan A, B, C, D, F, G, K, or L (Plans C and F are only available to those eligible for Medicare prior to 2020).  

Timeframe: A Medicare Supplement must be purchased within 63 days of coverage ending.

5. Your Medicare Supplement Insurer Failed to Meet Obligations

If your insurer’s marketing materials or representative were misleading or quality standards were not met, then you will be eligible for guaranteed issue and may purchase a Medicare Supplement Plan A, B, C, D, F, G, K, or L (Plans C and F are only available to those eligible for Medicare prior to 2020).  

Timeframe: You must enroll 63 calendar days from the date your coverage ended.

6. You Utilize Enrollment Trial Rights

If you enroll in a Medicare Advantage plan when you were first eligible at 65, you get a 12-month trial run. If you decide you want to switch to Original Medicare and obtain a Medicare Supplement, you have the right to buy any Medigap policy that is sold by an insurance company within your state.

Timeframe: You must enroll as early as 63 days before the date your coverage will end, and no later than 63 days after your coverage ends.

7. You Utilize Medigap Policy Trial Rights

If you dropped your Medicare Supplement plan to join a Medicare Advantage plan (or to enroll in a Medicare SELECT plan) for the first time, and you have been in the plan for less than a year and want to go back to your Medicare Supplement plan, you may due so based off your trial rights. You must go back to the Medicare Supplement policy you had before joining the Medicare Advantage plan if it is still available. If it is not still available, you may purchase another Medigap plan that is sold by any insurance carrier.

Timeframe: You must enroll as early as 63 days before the date your coverage will end, and no later than 63 days after your coverage ends.

Can I Purchase Supplemental Insurance Without a Guaranteed Issue Right?

If you do not qualify for a guaranteed issue right, you still may be able to purchase a Medicare Supplement policy. Each insurance company has their own set of medical underwriting guidelines. This is why it is important to use an insurance agent that has access to various companies and can see which is a good fit for you based off your past or current health conditions. Whether you are guaranteed issue or not, our advisors at MWG Direct can assist you with all your Medicare options. Give us a call at (877) 759-5762 or visit our website to get started today!