Medicare Supplement plans include specified “Guaranteed Issue” periods that enable people to apply for a plan without being denied coverage, having their pre-existing illnesses excluded, or being charged extra because of any health concerns. These guaranteed issue (GI) rights are required by the Centers for Medicare & Medicaid Services and apply to all Medicare members who fall into one of the specified categories.
The GI rights normally apply when your existing health care coverage is changing in a certain manner or when you are involuntarily losing your coverage. Specific insurance companies around have the authority to construct their own GI conditions, and they do so; nonetheless, there are seven federally-prescribed GI scenarios that all Medicare supplement plans companies must adhere to. If you fall into one of these categories, you should be eligible to enroll in a Medicare Supplement plan on a Guaranteed Issue basis. The following are the seven situations:
- You have employer or union coverage that pays after Medicare, and that coverage is about to expire
- You are enrolled in a Medicare Advantage plan, and the plan is exiting the Medicare program, quits serving your region, or you are relocating out of the plan’s specified service area.
- You have a Medicare SELECT insurance, and you are relocating outside of the plan’s coverage region. You have the option of keeping your existing insurance, but you also have the option of switching to a new coverage on a GI basis.
- If your Medicare Supplement business goes bankrupt, you will lose your coverage. Alternatively, you may lose your Medicare supplement plans coverage through no fault of your own.
- You registered in a Medicare Advantage plan or PACE when you were initially eligible to do so, and you desire to return to “original” Medicare within a year of doing so (and a Medicare Supplement plan).
- You decided to forego a Medicare Supplement in order to enroll in a Medicare Advantage or Medicare SELECT coverage for the first time. You have been enrolled in that plan for less than a year and desire to return to Medigap.
- You decide to cancel a Medigap coverage or quit a Medicare Advantage plan because the company itself hasn’t followed the requirements or has deceived you in some manner.
Individual states also have the power to establish other GI circumstances, which several have done in the past. Additionally, some of the unique GI scenarios have certain limitations for the plans that you may enter. For example, you may be qualified for a GI into a Medicare Supplement plan; yet, you may only be able to enroll in one of a few specific plans. If you are a Medicare beneficiary, it is beneficial for you to be aware of these assured issue scenarios. You will very certainly be required to meet medical requirements for a Medicare Supplement plan if you fall into one of these categories and do not enroll in a plan during the GI period.