Medigap (Medicare Supplement Insurance) helps cover out-of-pocket costs that Original Medicare (Parts A & B) doesn’t. However, getting approved for a Medigap plan isn’t always guaranteed—except in certain situations where Guaranteed Issue Rights (GIRs) apply.
These rights allow Medicare beneficiaries to buy certain Medigap plans without medical underwriting, meaning insurers cannot deny coverage or charge higher premiums due to health conditions. Understanding these protections is essential if you’re losing coverage or switching from another Medicare plan.
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What Are Guaranteed Issue Rights?
Guaranteed Issue Rights (GIRs) allow you to purchase a Medigap policy without health screenings. Insurers must accept your application and cannot charge more based on pre-existing conditions.
Guaranteed Issue Rights vs. Medigap Open Enrollment
- Open Enrollment: A six-month window when enrolling in Medicare Part B at 65. You can buy any Medigap plan.
- Guaranteed Issue Rights: Apply only in specific situations. You can buy only certain Medigap plans.
When Do Guaranteed Issue Rights Apply?
These rights apply when you lose certain coverage or need to return to Original Medicare.
- Losing Employer or Union Coverage: If your retiree or union plan ends, you must apply for Medigap within 60 days.
- Medigap Trial Rights: If you enroll in Medicare Advantage for the first time, you have a 12-month trial period to return to Medigap.
- Medicare Advantage Plan Closure: If your plan stops operating in your area, you qualify for Guaranteed Issue Rights.
- Moving Out of a Medicare Advantage Plan Service Area: Relocating may trigger a Special Enrollment Period to switch back to Medigap.
- Losing Medigap Coverage Through No Fault of Your Own: If your insurer goes bankrupt, you can switch without underwriting.
Which Medigap Plans Are Available Under Guaranteed Issue Rights?
Under federal rules, Guaranteed Issue Rights apply only to specific Medigap plans:
- Available Plans: A, B, C, D, F, G, K, or L.
- Not Available: Plan M.
- Plan N: Availability depends on the insurance carrier.
Additionally, some people may be denied Medigap outside of guaranteed issue periods, so it’s important to act quickly.
State-Specific Rules for Guaranteed Issue Rights
Some states offer extra Medigap protections beyond federal requirements.
States with Year-Round Medigap Enrollment
- New York & Connecticut: Allow Medigap enrollment at any time without underwriting.
States with Special Medigap Switching Rights
- Massachusetts: Medigap plans are guaranteed issue during specific enrollment periods.
- Maine: Allows switching between Medigap plans once per year.
- Missouri: “Medigap Anniversary Rule” lets policyholders switch insurers once a year.
- California & Oregon: “Birthday Rule” provides a guaranteed issue window around a beneficiary’s birthday.
Other States with Expanded Protections
- Washington: Allows some Medigap enrollees to switch plans without medical underwriting.
- Illinois, Nevada, and Louisiana: Offer additional Medigap switching opportunities.
How Long Do Guaranteed Issue Rights Last?
Most Guaranteed Issue Rights last 60 days from the date you lose your coverage. Applying early helps avoid gaps in coverage.
How to Apply for a Medigap Plan Using Guaranteed Issue Rights
- Identify Your Qualifying Event: Determine which Guaranteed Issue situation applies to you.
- Gather Proof of Eligibility: You may need a letter from your previous insurer.
- Compare Medigap Plans: Choose from Plans A, B, C, D, F, G, K, or L.
- Apply Within 60 Days: Submit your application before the deadline.
Learn more about changing Medigap plans and switching coverage.
Common Misconceptions About Guaranteed Issue Rights
- “I can switch Medigap plans anytime.” (Only true in certain states.)
- “Guaranteed Issue Rights apply to all Medigap plans.” (Only a limited set.)
- “I have unlimited time to enroll.” (The window is only 60 days.)
Frequently Asked Questions (FAQs)
1. What’s the difference between Open Enrollment and Guaranteed Issue Rights?
Open Enrollment lasts six months and lets you buy any Medigap plan. Guaranteed Issue Rights apply only in certain cases and cover a limited number of plans.
2. Can I get Plan G under Guaranteed Issue Rights?
Yes, if the insurance carrier offers it in your area.
3. What happens if I miss the 60-day window?
You may have to go through medical underwriting, and insurers could deny coverage.
4. Do all states follow the same Guaranteed Issue rules?
No, some states offer extra protections, such as year-round enrollment.
Conclusion
Guaranteed Issue Rights protect Medicare beneficiaries by ensuring access to Medigap coverage in specific situations. If you qualify, comparing plans early can help you find the best coverage without underwriting concerns.
Find out which Medigap plans are available in your area: