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What Is Guaranteed Issue for Medicare?

After the introduction of the Affordable Care Act (otherwise called Obamacare), many people started assuming that pre-existing conditions were no longer relevant for healthcare. Unfortunately, that is not the case. In Medicare, pre-existing conditions can apply in some situations.

Before you enroll in any Medicare plans, you should take the time to understand something called guaranteed issue rights and how they apply to Medicare Supplement plans.

What Are Guaranteed Issue Rights?

Guaranteed issue rights give you the ability to enroll in any Medicare Supplement plan of your choosing, regardless of your current or past health history. No insurance company can deny coverage based on your health, nor can they increase your premium due to past claims. In addition, if you have guaranteed issue rights, they cannot deny future claims based on a pre-existing medical diagnosis.

Guaranteed issue rights do not apply to Original Medicare (Parts A and B), Medicare Advantage plans, or Part D prescription drug plans. When we talk about GI rights and pre-existing conditions, we are only talking about how they impact your Medicare Supplement plan enrollment.

National Guaranteed Issue Rules

There are about eight instances when you’ll have guaranteed issue rights to a Medicare Supplement plan, no matter where you live. These eight situations apply to everyone in the U.S. In most cases, you can enroll in any of the Medicare Supplements available, but remember that you can only enroll in Plans C and F if you were on both Parts of Medicare before 2020.

You Turn 65. Every person has guaranteed issue rights when they first turn eligible for Medicare – when they turn 65. Each person has a 6-month enrollment period, starting the month of their birthday. During those six months, you can choose to enroll in any Medicare Supplement plan you want.

You Lose Creditable Coverage. Not everyone enrolls in Medicare at 65. If you’re still working (or your spouse is) and you have creditable coverage, you can delay your Medicare enrollment as long as you wish. When you do terminate that creditable coverage, you have GI rights for any Medicare Supplement plan for up to 63 days after your plan terminates.

Your Current Medicare Supplement Plan Ends. This only applies if the insurance company terminates your plan due to no fault of your own. For example, if the carrier goes bankrupt, you’ll lose your coverage and be allowed to enroll in another Medicare Supplement plan. You have 63 days to choose a new plan.

You Have Medicare SELECT and Move Out of the Area. A Medicare SELECT plan is like a Medicare Supplement plan, but it requires members to utilize a provider network. If you move from the service area, you have 63 days to enroll in a new Medigap plan.

You Joined a Medicare Advantage (Part C) Plan for the First Time at Age 65. Medicare Advantage is a great option for many people. However, if you enroll in it when you turn 65 and decide you’d like to go back to Original Medicare with a Medicare Supplement, you have GI rights for a 12-month trial period. You should enroll about 63 days before your Part C plan ends.

You Dropped a Medicare Supplement Plan to Join Medicare Advantage for the First Time. This is a similar situation to the one above, with a small difference. If you were on a Medicare Supplement plan and then chose to switch to Medicare Advantage for the first time, you have the same 12-month trial period. During that time, you can go back to the Medicare Supplement you were originally on.

Your Medicare Advantage Plan Leaves the Area. Medicare Advantage plans in Texas (and everywhere else) run on annual contracts, which means they’re always changing. Sometimes, they may even choose to leave your service area. If this happens, you can choose a different Medicare Advantage plan or enroll in a Medicare Supplement plan.

You Were Misled by the Insurance Company or They Violated Medicare Rules. This one might prove a little tricky to prove, but if you have a Medicare Supplement or Medicare Advantage plan, you’ll have GI rights to a new Medicare Supplement plan if the current carrier misleads you.

State-Specific Guaranteed Issue Rules

While the above rules apply to anyone, you may have additional GI rights unique to your state. Medicare Supplements in Texas do not have any extra opportunities, but let’s look at some other states.

California, Idaho, Illinois, Louisiana, Nevada, and Oregon all have the birthday rule. The birthday rule allows you to switch your Medigap plan for a period of time around your birthday. You can change to a plan of equal or lesser benefits.

Maine has an open enrollment period in June when everyone has GI rights. Missouri allows people with a Medicare Supplement to change to a like plan on their plan’s anniversary date. Lastly, Connecticut, Vermont, New York, and Washington have year-round GI rights. (Some restrictions apply.)

If you’re curious about guaranteed issue rights in Texas, call the advisors at Cover Mile. We’ll help you determine if you’re eligible to switch your current plan and look for other cost-saving options.