What Are Guaranteed Issue Rights With Medicare?

Guaranteed Issue Rights are also referred to as “Medigap Protections.” These are rights that you are entitled to where insurance companies are required to offer certain Medigap policies. When this situation arises, insurance companies are required to:

  • Sell you a Medigap policy
  • Must cover all your pre-existing health conditions
  • Cannot charge you a higher price for a Medigap policy due to past or present health conditions. 

You typically have a guaranteed issue right when your health coverage changes, such as losing your current health insurance. Other circumstances allow you a “trial right” that allows you to try a Medicare Part C plan, also known as Medicare Advantage plans, while still having the option to purchase a Medigap policy if you prefer something different. 

When Can You Implement Your Guaranteed Issue Rights?

There are seven different circumstances that allow you to exercise your Guaranteed Issue Rights offered through Medicare. 

  1. You are currently enrolled in a Medicare Advantage plan and your plan stops providing coverage in your area, or you move out of your coverage area.
  2. You are currently enrolled in Original Medicare, and your employer group health plan or union coverage that covers costs after Medicare pays is ending. Enrollment in COBRA insurance allows you to enroll in a Medigap policy immediately. You have 63 days to enroll in a Medigap policy after the latest of these three dates: coverage end date, the date that notices coverage is ending, and the date on a claim denial. 
  3. You are enrolled in Original Medicare and a Medicare SELECT policy, and you move out of the SELECT coverage area. 
  4. You enrolled in a Medicare Advantage plan or PACE plan when you first became eligible for Medicare Part A when you turned 65 but decided you wanted to enroll in Original Medicare instead. You must decide this within the first year of enrollment. 
  5. You ended a Medigap policy to enroll in a Medicare Advantage plan or switch to a Medicare SELECT policy for the first time, but you have been in your plan less than one year, and you choose to switch back. 
  6. The Medigap insurance company that provides your coverage files bankruptcy, causing you to lose your coverage, or your Medigap policy ends due to no fault of your own.
  7. Your Medigap policy did not follow the rules or provided you with misleading information. 

Call Us Today For More Information!

At Carolina Senior Benefits, we’re devoted to providing you with the information you need to make educated decisions on your Medicare coverage. To learn more about your options and the rights you have with Medicare, give us a call!