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Home Medicare Basics[cols2] Medicare Basics 7 Guarantee Issue Rights
7 Guarantee Issue Rights

If you experience any of the following situations, you have the right to buy Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company. The insurance company cannot delay your effective date for any pre-existing health condition or charge you more because of any health problems. Generally, you can apply as early as 60 calendar days before the date your health care coverage will end, if known, but no later than 63 calendar days after your health care coverage ends. NOTE: If you apply during the 63 days after your health care coverage ended, your Medigap policy cannot become effective before the date you apply for it.

1.  You are in 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.

2.  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. NOTE: In this situation, you may have additional rights under state law.

3.  You have Original Medicare and a Medicare SELECT policy and you move out of the SELECT policy's service area.

4.  Your Medigap insurance company goes bankrupt and you lose your coverage or your Medigap policy coverage otherwise ends through no fault of your own.

5.  You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you.

If you experience the following, you have the right to buy any Medigap policy that is sold in your state by any insurance company. You can apply as early as 60 days before the date your coverage will end but no later than 63 days after your coverage ends. NOTE: If you apply during the 63 days after your health care coverage ended, your Medigap policy cannot become effective before the date you apply for it and you will only be covered by Original Medicare.

6.  You joined a Medicare Advantage Plan or Program of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at age 65, and within the first year of joining, you decide you want to switch to Original Medicare. NOTE: You will have an additional 12 months in this situation if you were initially covered by a Medicare Advantage Plan that left Medicare or stopped giving care in your area and you joined a new Medicare Advantage Plan instead of Original Medicare. (Trial Right)

If you experience the following, you have the right to return to the Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy if the insurance company you had before still sells it. If your Medigap plan included drug coverage, you can still get that same policy, but without the drug coverage. If your former Medigap policy isn't available, you can buy a Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company. NOTE: If you apply during the 63 days after your health care coverage ended, your Medigap policy cannot become effective before the date you apply for it and you will only be covered by Original Medicare.

7.  You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time; you have been in the plan for less than a year, and you want to switch back to Original Medicare. NOTE: You will have an additional 12 months in this situation if your original Medicare Advantage Plan or Medicare SELECT policy left Medicare or stopped giving care in your area and you joined a new Medicare Advantage Plan or Medicare SELECT policy rather than returning to Original Medicare. (Trial Right)

 

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