Medicare Guaranteed Issue Rights by State

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Medicare Guaranteed Issue Rights by State

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By Daniel Petkevich

Feb 10, 2023

Guaranteed Issue Rights in some States Are More Favorable than Others

If you have any pre-existing medical conditions, changes to your Medigap Plan made outside the Open Enrollment Period may limit your plan choices.

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Fortunately, Guaranteed Issue rights offer relief if your coverage is lost due to a qualifying event, allowing you to choose a plan even if you have a pre-existing condition. But, these rights may differ across states based on your situation.

Let's look at Guaranteed Issue rights and how they vary from state to state.

What Are Guaranteed Issue Rights?

Guaranteed Issue Rights, also called Medigap Protections, are your rights in specific situations that permit you to choose any Medicare Supplement (

Medigap

) plan without medical underwriting.

In medical underwriting, insurance companies examine your medical history, including your medical records and prescription history, to determine whether to offer insurance and at what cost.

If you have guaranteed issue rights, insurance companies:

Are legally obligated to sell you a Medicare Supplement (Medigap) policy
Cannot reject your application
Must cover all your pre-existing conditions
Cannot overcharge you due to a pre-existing condition

When Do You Have Guaranteed Issue Rights?

Guaranteed Issue Rights are only available under specific conditions, so it's good to enroll in a Medigap or Medicare Supplement plan during your

Medigap Open Enrollment Period

You're eligible for guaranteed issue rights under the following situations:

If you're enrolled in a
Medicare Advantage plan
and:
1. It will no longer be part of Medicare
2. It's discontinuing its service in your region, or
3. You move outside of your plan's service area
When your employer group health plan or union coverage that supplements Original Medicare is ending
If you have a
Medicare SELECT
plan and you decide to move out of its service area
When your Medigap Insurance company goes bankrupt, or your plan coverage ends through no fault of your own
If you leave a Medicare Advantage Plan or a Medigap plan because your insurance company didn't follow the rules or misled you

In a similar vein, you have Trial Rights 1 and 2:

If you enrolled in a Medicare Advantage plan or
PACE (Program of All-inclusive Care for the Elderly)
during your
Initial Enrollment Period
and within the first year decide to return to Original Medicare
If you dropped a Medigap plan to enroll in a Medicare Advantage plan (or Medicare SELECT plan) for the first time and, within the first year and decide to switch back

Note: There may be times when more than one of the situations above applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice.

What Happens if Your Medicare Supplement Plan Discontinues Your Coverage?

If your insurance provider moves out of your service area, goes bankrupt, or discontinues your coverage for reasons that don't involve you, then:

You can choose a Medigap plan* sold by any insurance provider in your state
You can apply for a Medicare Supplement (Medigap) plan starting 60 days before your coverage ends until 63 days after your coverage has expired

To apply for a plan change with guaranteed issue rights, you must have the following information:

A disenrollment letter from your insurance company
The date your coverage ends
Your name (or the applicant's name) on the documentation

*Note: If you're eligible for Medicare after January 1, 2020, you cannot use guaranteed issue rights to enroll in Medicare Supplement Plan F.

What Happens if Your Employer Plan Ends?

If your employer group health plan or union coverage is ending, you can choose most Medigap plans* sold by any insurance provider in your state. Don't bank on your retirement plan or

COBRA

to cover you, as they might not be considered

creditable coverage

The latest you may apply for a Medigap policy is 63 calendar days after one of the following three events:

The end of your coverage
The date of the notification informing you of the coverage termination (if received)
The date of a denied claim, if it was the only way to determine coverage termination

Note: Under certain conditions, your rights may be extended for 12 months (To learn more about this,

talk with one of our advisors

When applying for a Medigap plan, keep a record of the following items:

Copies of any letters, notices, emails, or claim denials that include your name as evidence of your coverage termination
The postmarked envelope these documents came in as proof of the mailing date

You may need to submit some or all of these documents with your Medigap application to prove your guaranteed issue right.

If You Voluntarily Lose Your Group Coverage

If you lose your insurance coverage without canceling it or due to non-payment, it's considered involuntary, and you may be eligible for guaranteed issued rights.

However, if you choose to leave your group coverage voluntarily, keep the following information handy while applying for a Medigap plan:

The date the coverage ends
Documentation from your employer or carrier on their letterhead
Information about whether the coverage was primary or secondary

What Happens if Your Insurance Provider Misleads You?

If an insurance provider misleads you or violates the regulations for Medicare Supplement plans, you may be eligible for guaranteed issue rights to enroll in a new plan.

To claim this, you may have to file a complaint with Medicare, and if your appeal is approved, you'll receive a guaranteed right to enroll in a new plan.

However, you must apply for your new Medigap plan within 63 days of your coverage ending.

How Do Medicare Guaranteed Issue Rights Differ by State?

As a federal program, Medicare allows states to impose additional rules as long as they adhere to the fundamental Medicare standards. Some states have implemented favorable regulations to assist seniors in adjusting their Medigap plans.

Here's a brief on different state-specific guaranteed issue rights.

1. Annual or Continuous Guaranteed Issue Rights

Missouri — Once a year, during your policy anniversary, you can switch to a Medigap plan with similar or lesser benefits. This window of opportunity starts 30 days before your policy anniversary and ends 30 days after.

Washington — Has year-round guaranteed issue rights. You can switch to a similar or lower-benefit plan at any time.

California and Oregon — These states follow the Birthday Rule, which means that you can change your plan up to 30 days before and 30 days after your birthday each year.

Massachusetts — Has a state-specific Medigap Open Enrollment Window from February 1 to March 31 each year.

2. Voluntary group termination

In some states, voluntarily terminating a group health plan does not grant guaranteed issue rights. But, some states allow the transition from employer coverage to Medigap using guaranteed issue rights. These states are:

Alaska
Arkansas
California
Colorado
Florida
Idaho
Illinois
Indiana
Iowa
Kansas
Louisiana
Maine
Missouri
Montana
Nevada
New Jersey
New Mexico
Ohio
Oklahoma
Pennsylvania
South Dakota
Texas
Virginia
West Virginia
Wisconsin

State-Specific Medicare Guaranteed Issue Rights for Group Termination

‎

In addition to state-specific guaranteed issue rights, some states also provide continuous or annual open enrollment periods to help Medicare beneficiaries change their plans.

3. Annual or Continuous Open Enrollment Period

Some states allow you to change Medigap plans at any time or at specific times without undergoing medical underwriting. These states are:

Connecticut
New York
Vermont — only for Mutual of Omaha and UnitedHealthcare plans
Maine — Offers Open Enrollment annually in June. You can switch to a similar or lower-benefit plan without medical underwriting during this period

Guaranteed Issue Rights and Open Enrollment Window

‎

What Documents Do You Need When Using Your Guaranteed Issue Rights?

If you're eligible for guaranteed issue rights, you'll need to provide documentation before switching plans.

For a Medigap-to-Medigap policy change, you'll need the following:

A copy of your current Medicare Supplement ID card with your current plan letter and your name
Proof of payment for the last three months that includes your full name

For a Medicare Advantage-to-Supplement policy change, you'll need the following:

Proof of disenrollment
The policy end date

Stay up-to-date with Your State Regulations to Optimize Your Medicare Benefits

Guaranteed Issue rights are important to the Medicare program, allowing you to access essential medical coverage during life events or circumstances that result in the loss of your existing plan.

However, Guaranteed Issue Rights vary among states, with some offering more favorable regulations for seniors and those with disabilities. Learn your state's regulations to make the most of the benefits provided by Medicare.

If you have any questions or need assistance in understanding your guaranteed issue rights, call us at 1-888-376-2028.

Our team of experts

is dedicated to helping you make informed decisions about your healthcare coverage, so you can get the necessary support and treatment.

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Medicare Guaranteed Issue Rights by State

Guaranteed Issue Rights in some States Are More Favorable than Others

Stay Up to Date on Medicare!

What Are Guaranteed Issue Rights?

When Do You Have Guaranteed Issue Rights?

What Happens if Your Medicare Supplement Plan Discontinues Your Coverage?

What Happens if Your Employer Plan Ends?

If You Voluntarily Lose Your Group Coverage

What Happens if Your Insurance Provider Misleads You?

How Do Medicare Guaranteed Issue Rights Differ by State?

1. Annual or Continuous Guaranteed Issue Rights

2. Voluntary group termination

3. Annual or Continuous Open Enrollment Period

What Documents Do You Need When Using Your Guaranteed Issue Rights?

Stay up-to-date with Your State Regulations to Optimize Your Medicare Benefits

Stay Up to Date on Medicare!

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