If you’re over the age of 65 and enrolled in Medicare A and/or B, you might be considering a Medigap plan to supplement your Medicare coverage. However, there are guidelines regarding how and when you can purchase a Medigap plan. More specifically, it is important to learn the difference between a Guaranteed Issue Medicare supplement and Open Enrollment.
Medicare Supplement Open Enrollment vs. Guaranteed Issue
Most Medicare beneficiaries sign up for supplemental coverage during the open enrollment period. By law, open enrollment begins the month you turn 65 and lasts for a period of six months. Open enrollment gives you the opportunity to purchase a Medigap plan at the best possible price without any health underwriting.
What is the difference between open enrollment and guaranteed issue?
During Open Enrollment, you are not required to answer any medical questions and insurers cannot deny your supplemental application For these reasons, many people apply for a Medigap plan during the Open Enrollment window. Open Enrollment is a one-time opportunity (with some exceptions), once it’s over you might not get another chance to get a low-cost supplemental Medicare plan.
Fortunately, if you do miss your open enrollment period, you can still take advantage of the same benefits with a guaranteed issue right. There are several different guaranteed issue scenarios outlined below:
- Trial Rights – If you enrolled in a Medicare Advantage Plan when you were first eligible for Medicare Part A, but later decide that you would like Original Medicare (within 12 months of enrollment), you can exercise your trial right to access Medicare supplement plans. However, you must purchase coverage no earlier than 60 days before and no later than 63 days after your coverage ends.
- Lost Coverage – If you lose access to your Medicare Advantage plan, employer group health plan, or an existing Medicare supplement plan (through no fault of your own), you can purchase a new Medicare supplement plan within 63 days of losing your coverage.
- Change of Address – If you move out of the coverage area for a Medicare Advantage or Medicare SELECT plan, you can apply for supplemental insurance no earlier than 60 days before and no later than 63 days after you lose access to your coverage.
There are several other situations in which you might qualify for guaranteed issue, these are some of the most common scenarios. You can learn more about the guaranteed issue for medicare supplement guidelines on Medicare.gov.
AGENT TIP:To find a policy that fits your needs, check out our Medicare Supplement Ultimate Guide here.
Can I buy a Medicare supplement at any time?
Yes, you can buy a Medicare supplement outside of the open enrollment period. However, unless you qualify for a guaranteed issue Medicare supplement, you will not get the same benefits as you would during open enrollment. You will have to answer medical questions referred to as “underwriting” about yourself. The insurers reserve the right to charge higher premiums or even deny coverage based on preexisting conditions.
Medicare Supplement Plans
There are 8 primary plans that are available during a guaranteed issue window (depending on when you became eligible for Medicare): A, B, C*, D, F*, G, K, or L. *Those who qualified for Medicare prior to January 1st, 2020 have access to the C and F plans.
Learn more about what Medigap company is best by checking out our carrier reviews here.
Guaranteed Issue FAQs
While the resources provided above should give you an overview of Medicare supplement plans, they may not answer more specific questions about different plans or guaranteed issue scenarios. Let’s take a look at a few Frequently Asked Questions related to guaranteed issue and Medigap coverage:
Can I use Plan C with a guaranteed issue?
Yes, Plan C is available to purchase during the guaranteed issue window. However, Plan C is slowly being phased out. This means that you would need to have qualified for Medicare prior to January 1st, 2020. If you qualified for Medicare after this date, you must obtain a different supplemental insurance plan.
Can I use Plan F with a guaranteed issue?
Yes, folks in need of supplemental coverage can access Plan F during a guaranteed issue window. However, just like Plan C, Plan F is being phased out. If you qualified for Medicare Part A prior to January 1st, 2020, you can enroll in Plan F with a guaranteed issue right. Otherwise, you will need to obtain a different plan.
Can I use Plan G with a guaranteed issue?
Plan G is not available during a guaranteed issue window unless you become eligible for Medicare Part A after January 1st, 2020. Otherwise, you will need to purchase Plan G during the open enrollment period to qualify or be approved in health underwriting.
If you became eligible for Medicare Part A before January 1st, 2020 then you can purchase Plan F Guarantee Issue.
How is pricing calculated with a guaranteed issue Medicare supplement?
As previously stated, the guaranteed issue window grants you the same benefits as the open enrollment. This means that insurers must provide the best possible prices for your circumstances. That said, not every Medigap plan is priced the same way. There are three basic pricing models for Medicare supplements:
- Current Age Pricing – Your Medigap insurance premium is calculated based on your current age. As you get older, your premiums will increase accordingly.
- Entry Age Pricing – Your Medigap insurance premium is calculated based on the age you were when you first purchased the policy. Your premium will not change over time.
- Community Pricing – Premiums are the same for everyone who obtains the policy.
Read more about how Medigap plans are priced here.
Can I qualify for a new guaranteed issue Medicare supplement if I don’t like my current one?
Disliking your policy is not enough to qualify for a new guaranteed issue window. However, you can qualify for a new GI window if you show proof that your insurer either did not follow the rules or attempted to mislead you in some way. If this occurs, you can drop your policy and obtain a new policy with your guaranteed issue right.
AGENT TIP:You can access All Medigap plans during your initial Open Enrollment Period. This period starts the first of the month you turn 65 or start Medicare Part B and lasts for 6 months.
Guaranteed Issue States
Federal law offers limited protections for those aged 65 and older who wish to purchase a Medigap supplemental plan. However, laws and protections can vary by state. More specifically, there are 4 states that offer additional guaranteed issue protections for consumers:
- New York
All four of these states require Medigap insurers to offer either continuous or annual open enrollment to all qualifying beneficiaries. The remaining states (and Washington DC) only provide minimum federal protections, though many offer additional qualifying events for Open Enrollment as well.
Call us at (800) 208-4974 for a FREE quote comparison for your guaranteed issue Medicare supplement coverage!
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Alex Wender is the founder and CEO of Bluewave Insurance. He has been blogging about Medicare-related topics since 2010. Since then, he and his agency have helped thousands of people across the country choose the right Medicare to fit their needs.