Guaranteed Issue Periods for Medicare Supplement Plans
1. If 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.
Then you can purchase a Medicare Supplement Plan A, B, C, F, K, or L that is sold in your state by any insurance company. If you have COBRA coverage, you can either buy a Medicare Supplement plan right away or wait until the COBRA coverage ends.
When: No later than 63 calendar days after the latest of these 3 dates:
Situation 2: You have Original Medicare (Part A and Part B) combined with an employer group health plan or union coverage that pays after Medicare pays its share of covered costs.
What happens: Your employer group health plan, including retiree, COBRA, or union coverage is ending.
What you can do with guaranteed issue: In most states, you can typically buy any of the limited Medicare Supplement insurance plans available to you (Plan A, B, C**, D, F**, G, K or L) no later than 63 days after any of these:
Date your employer-based or union-based coverage ends
Date on the notice telling you that your coverage is ending
The date on your claim denial (if this the only way you know your coverage is ended)
If you have COBRA coverage, you can usually either buy a Medicare Supplement insurance plan right away or wait until the COBRA coverage ends.
2. You are in a Medicare Supplement Plan or a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area.
You can purchase plans A, B, C, F, K or L.
When: As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.
Situation 1: You have a Medicare Advantage plan.
What happens: Your Medicare Advantage plan leaves Medicare or stops giving care in your area, or you move out of the plan’s service area.
What you can do with guaranteed issue:
As early as 60 calendar days before your coverage ends but not more than 63 days after your coverage ends, you can apply for any of the Medicare Supplement insurance plans listed above if you decide to switch to Original Medicare rather than enrolling in another Medicare Advantage plan. Your Medicare Supplement basic benefits won’t begin until your Medicare Advantage coverage ends.
3. You have original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area.
You can purchase a Medicare Supplement Plan A, B, C, F, K, or L that is sold by any insurance company in your state or the state you are moving to.
When: As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage
Situation 3: You have Original Medicare and a Medicare SELECT insurance plan. (Medicare SELECT is a type of Medicare Supplement insurance plan that may require you to use hospitals and doctors in-network in order to be fully eligible for benefits)
What happens: You move out of the Medicare SELECT plan’s service area.
What you can do with guaranteed issue: As early as 60 calendar days before the date your Medicare SELECT coverage will end but not more than 63 calendar days after you Medicare SELECT coverage ends, you can generally buy any Medigap insurance Plan A, B, C**, D, F**, G, K or L that’s sold in your state.
4. You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for original Medicare at age 65, you have a “trial right” which allows you to switch back to original Medicare.
You can purchase any Medicare Supplement Plan that is sold in your state by any insurance company.
When: As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.
5. You purchase a Medicare Advantage plan during your “trial right” which allows you to drop your Medicare Advantage plan and purchase a Medicare Supplement plan if you change your mind within the first 12 months of enrollment in a Medicare Advantage plan.
You can purchase the Medicare Supplement Plan 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 Medicare Supplement Plan is not available, you can buy a Medicare Supplement Plan A, B, C, F, K or L that is sold in your state by any insurance company.
When: As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.
Situation 4: You are in a trial right of Medicare Advantage, meaning that you joined a Medicare Advantage plan when you were first eligible for Medicare Part A at age 65 but you changed your mind.
What happens: Within 12 months of joining Medicare Advantage you decide you want to switch to Original Medicare.
What you can do with guaranteed issue: As early as 60 calendar days before the date your coverage will end but no later than 63 days after your coverage ends, you have the right to buy any Medicare Supplement insurance plan listed above that is sold in your state by any insurance company
Situation 5: You dropped a Medicare Supplement insurance plan to join a Medicare Advantage plan or you switch to a Medicare SELECT insurance plan (another example of a trial right).
What happens: In less than a year, you decide you want to switch back to your Medicare Supplement insurance plan.
What you can do with guaranteed issue: As early as 60 calendar days before your coverage will end but no later than 63 calendar days after your coverage ends, you can buy the same Medicare Supplement insurance plan you had before you joined Medicare Advantage or Medicare SELECT insurance plan (if the company you had before still sells it). If your former plan is no longer available, you can buy any Medigap insurance Plan A, B, C**, D, F**, G, K or L that’s sold in your state.
6. Your Medicare Supplement Plan’s insurance company goes bankrupt and you lose your coverage, or your Medicare Supplement Plan coverage otherwise ends through no fault of your own.
You can purchase a Medicare Supplement Plan A, B, C, F, K, or L that is sold in your state by any insurance company.
When: No later than 63 calendar days from the date your coverage ends.
Situation 6: You lose your Medicare Supplement insurance plan.
What happens: Your Medicare Supplement company goes bankrupt and you lose coverage through no fault of your own, or your Medicare Supplement company hasn’t followed the rules or misled you.
What you can do with guaranteed issue: No later than 63 calendar days from the date your coverage ends, you can buy a Medigap insurance Plan A, B, C**, D, F**, G, K or L.
7. You leave a Medicare Advantage Plan or drop a Medicare Supplement Plan because the company has not followed the rules, or it misled you.
You can purchase a Medicare Supplement Plan A, B, C, F, K, or L that is sold in your state by any insurance company.
When: No later than 63 calendar days from the date your coverage ends.
8. If you did not enroll in Medicare when you were first eligible (age 65) and you apply during the General Open Enrollment Period for original Medicare Part A and/or Part B, you have a six month Open Enrollment Period for enrollment into a Medicare Supplement Plan.
You can purchase a any Medicare Supplement Plan sold in your state by any insurance company.
When: Within six months from the effective date of your original Medicare Part B.
Guaranteed-issue rights may protect you from medical underwriting. Health insurance companies often use your health history and data on pre-existing conditions* to make determinations about whether or not they will cover you and how much they will charge you for coverage. This process is called medical underwriting
Specific situations in which you usually have guaranteed-issue rights are described below. Some states may allow additional situations to qualify you for guaranteed-issue rights. Outside of your Medicare Supplement OEP, guaranteed-issue rights are often limited to certain Medicare Supplement insurance plans: A, B, C**, D, F**, G, K, or L.
