Medicare Supplement plans have a unique set of rules compared to the rest of Medicare. Every other aspect of Medicare has very rigid times when you can enroll, disenroll, or change plans. With Supplements you can make changes any time of the year. This is often surprising yet welcomed. However, this freedom is not without a “catch.”
Since Medicare Supplement plans do not have an annual maximum pay limit and are not funded directly by the government (such as with Parts C and D), they can deny your enrollment based on medical underwriting. That’s right, if your health is currently less than the standard set by the Supplement plan or has been in the past, then you could be denied enrollment into that plan. Now, if you are currently enrolled in a Supplement plan, then there is no need to worry. Once enrolled, you will have guaranteed renewability each year. This means that once you’re in, you’re in, and the plan cannot kick you off based on diminishing health.
Generally, when you apply for a Medicare Supplement you will have to answer a series of questions about your health history and medications to see if the health plan is willing to accept you. Good News! There are a few exceptions to this and times when a Supplement plan must accept you no matter what. These are called your guaranteed issue rights.
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The most popular time to capitalize on a guaranteed issue right is when you first enroll into Medicare or when you first apply to have your Part B effective. You will have a short window before and after to enroll into a Medicare Supplement with a guarantee to be accepted. This window begins on the first day of your birth month, or the month that your Part B is effective, and it lasts for six months. It is a “use it or lose it” enrollment period. During this time period, the Medicare Supplement plan cannot ask you any medical questions for underwriting, and they cannot turn you away for any health conditions. They cannot refuse you a policy or charge you any additional amount due to health conditions, medications or pre-existing illnesses.
Allow us to really stress the importance of your guaranteed issue rights. Many individuals we meet find out about the cost of Medicare Supplement plans and feel it would be better to wait until their health gets worse (and therefore more expensive to manage) before they wish to enroll into a Supplement plan and pay the monthly premium that comes with it.
Important Note! It is not promised that you will have a guaranteed issue right available at that future date. Therefore, you may be subject to medical underwriting and a chance that you will be denied coverage.
This is not a scare tactic to have you quickly enroll into a Medicare Supplement. On the contrary, there are many great alternatives with Medicare Advantage plans. The takeaway is that if you really want the Medicare Supplement plan and it aligns with what is important to you, then it would be wise to enroll into one while it’s guaranteed. Below is a list of Medicare accepted guaranteed issue rights that all health plans must follow.
Guaranteed Issue Rights
These are just the guaranteed issue rights that all Medicare Supplement plans must adhere to. You will find that many plans offer a few other scenarios as well. Below are some examples of guaranteed issue rights many health plans may have.
You’re in a Medicare Advantage Plan and your plan is leaving Medicare or stops providing care in your service area, or you move out of the plan’s service area.
You have the right to buy a Medigap (Supplement) Plan A, B, C, F, K, or L that’s sold by any insurance company in your state. You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.You can/must apply for a Medigap (Supplement) policy:
- As early as 60 days before the date your coverage will end
- No later than 63 calendar days after your coverage ends Medicare Supplement coverage can’t start until your Medicare Advantage Plan coverage ends.
You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays, and that plan is ending.
You have the right to buy a Medigap (Supplement) Plan A, B, C, F, K, or L that’s sold by any insurance company in your state. If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.You can/must apply for a Medicare Supplement plan no later than 63 calendar days after the latest of these 3 dates:
- Date the coverage ends
- Date on the notice you receive telling you that coverage is ending (if you get one)
- Date on a claim denial, if this is the only way you know that your coverage has ended*Your rights may last for an extra 12 months under certain circumstances.
You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area.
You have the right to buy a Medigap (Supplement) Plan A, B, C, F, K, or L that’s sold by any insurance company in your state. You can/must apply for a Medicare Supplement plan:
- As early as 60 calendar days before the date your coverage will end
- No later than 63 calendar days after your coverage ends*Call the Medicare SELECT insurer for more information about your options.
You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)
You have the right to buy any Medigap (Supplement) policy that’s sold by any insurance company in your state. You can/must apply for a Medicare Supplement plan:
- As early as 60 calendar days before the date your coverage will end
- No later than 63 calendar days after your coverage ends*Your rights may last for an extra 12 months under certain circumstances.
You dropped a Medicare Supplement plan to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)
You have the right to buy the Medigap (Supplement) policy you had before you joined the Medicare Advantage plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If your former Medigap policy isn’t available, you can buy a Medigap (Supplement) plan A, B, C, F, K, or L that’s sold by any insurance company in your state. You can/must apply for a Medicare Supplement plan:
- As early as 60 calendar days before the date your coverage will end
- No later than 63 calendar days after your coverage ends *Your rights may last for an extra 12 months under certain circumstances.
Your Medicare Supplement insurance company goes bankrupt and you lose your coverage, or your Supplement policy coverage otherwise ends through no fault of your own.
You have the right to buy a Medigap (Supplement) Plan A, B, C, F, K, or L that’s sold by any insurance company in your state. You can/must apply for a Medicare Supplement plan no later than 63 calendar days from the date your coverage ends.
You leave a Medicare Advantage Plan or drop a Medicare Supplement because the company hasn’t followed the rules, or it misled you.
You have the right to buy a Medigap (Supplement) plan A, B, C, F, K, or L that’s sold by any insurance company in your state. You can/must apply for a Medicare Supplement plan no later than 63 calendar days from the date your coverage ends.
Birthday Rule: Based on your date of birth, you can choose to change your existing Medicare Supplement plan. You can choose a plan with the same or fewer benefits as your existing plan from any company.
You have the right to buy any Medigap (Supplement) policy that is sold in your state by any insurance company. You can/must apply for a Medicare Supplement plan no later than 30-days from your date of birth.
Medicare Advantage (MA) Plan Change: a) Your Medicare Advantage plan increased your premium or copayments, reduced your benefits, or terminated its relationship with your medical provider for reasons other than good cause relating to quality of care who was treating you. b) If the Medicare Advantage plan you belong to doesn’t sell a Medicare Supplement policy, you still have the right to buy a Medicare Supplement plan from any other company if the MA plan: (i) increased your premium or copayments by 15% or more, (ii) reduced your benefits, (iii) or terminated their relationship with your medical provider for reasons other than good cause relating to quality of care who was treating you.
You have the right to buy Medigap (Supplement) plan A, B, C, F, High F, K or L, M or N that is sold in your state by any insurance company. Medicare Supplement enrollment is only permitted during the annual election period for Medicare Advantage. You can/must apply for a Medicare Supplement plan no later than 63 calendar days from the date you are notified of any reduced benefits, increased premium or cost-sharing, or that your plan is no longer contracting with one of your medical providers. You will need to provide proof of benefit changes with your application.
You lose eligibility for full Medicaid (Medi-Cal) benefits due to an increase in income or assets and return to Original Medicare.
If over 65: You have the right to buy any Medigap (Supplement) policy that is sold in your state by any insurance company. Under 65: Medigap (Supplement) plan A, B, C, F, High F, K or L, M or N that is sold in your state by any insurance company. You can/must apply for a Medicare Supplement plan during the six month period beginning on the date of the receipt of notice of loss of eligibility, or if no such notice received, from the effective date of the loss of eligibility. You will need to provide proof of loss of eligibility.
Military: Health care services are terminated for a military retiree or the retiree’s Medicare eligible spouse or dependent as a result of a military base closure or loss of access to health care services because the base no longer offers services or because the individual relocates.
If over 65: You have the right to buy any Medigap (Supplement) policy that is sold in your state by any insurance company. Under 65: Medigap (Supplement) plan A, B, C, F, High F, K or L, M or N that is sold in your state by any insurance company. You can/must apply for a Medicare Supplement plan during the six month period beginning on the date of the receipt of notice of termination, or, if no such notice received, from the effective date of termination. You will need to provide proof of loss of coverage due to base closure, stoppage or services, or change of residence
Divorce or Death of Spouse: Loss of eligibility due to divorce or death of spouse from any employer sponsored health plan (including retiree, COBRA or Cal-COBRA)
If over 65: You have the right to buy any Medigap (Supplement) policy that is sold in your state by any insurance company. Under 65: Medigap (Supplement) plan A, B, C, F, High F, K or L, M or N that is sold in your state by any insurance company. You can/must apply for a Medicare Supplement plan during the six month period beginning on the date of the receipt of notice of termination, or, if no such notice received, from the effective date of termination. You will need to provide proof of loss of coverage due to base closure, stoppage or services, or change of residence.
You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)
You have the right to buy any Medigap (Supplement) policy that’s sold by any insurance company in your state. You can/must apply for a Medicare Supplement plan:
- As early as 60 calendar days before the date your coverage will end
- No later than 63 calendar days after your coverage ends*Your rights may last for an extra 12 months under certain circumstances.
Your Medicare Supplement insurance company goes bankrupt and you lose your coverage, or your Supplement policy coverage otherwise ends through no fault of your own.
You have the right to buy a Medigap (Supplement) Plan A, B, C, F, K, or L that’s sold by any insurance company in your state. You can/must apply for a Medicare Supplement plan no later than 63 calendar days from the date your coverage ends.
Guaranteed Issue Rights Don’t Apply To All Health Plans
As stated earlier these last five guaranteed issue rights do not apply to all health plans, but you may be able to find one in your service area in California that offers one of them. If you are having trouble finding out if you qualify for a guaranteed issue right, give us a call. If you are seriously interested in looking into a Medicare Supplement plan, it’s important that you get support from a trusted Medicare broker who can research your options and consult you based on your individual needs.
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