What are guaranteed issue rights?

 

Guaranteed issue rights (also called “Medigap protections”) are rights you have in some certain situations when insurance companies must offer you certain Medigap policies (also known as Medicare Supplements.) In this case, the insurance company must sell you a Medigap policy, cover all your previous health conditions, and won’t charge you more because of your medical history.

While these rights are provided by the federal government, additional rights can still be offered to individuals by some state governments. All Medigap policies must align with both the state and federal regulations, and are identified as Medicare Supplement Insurance Plans. Insurance companies selling these policies are free to choose the type of policies they offer and cannot cancel an individual’s policy if the policyholder paid the premium.

Policies often offer a standard profile of benefits although certain additional benefits may be added to suit individual needs. The policy applies to individuals only and not families.

In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan (Medicare Part C) and still buy a Medigap policy if you change your mind.

If you lose your health coverage, you can still have a guarantee issue to buy a Medigap policy but make sure you keep some of these items. They include; any form of proof of your coverage being terminated, this can be either a letter, emails, notices or claim denials that you have your name on. You may also need to send a copy of these documents along with your Medigap application to prove you indeed have a guaranteed issue right.

If you have a Medicare Advantage Plan but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the plan. Ask that the new policy take effect no later than when your Medicare Advantage enrollment ends, so you’ll have continuous coverage.

If you need more information regarding your guaranteed issue rights, Medicare Supplement Insurance Plans or Medicare Advantage please contact one of our licensed sales agents at 866-466-9118.