FAQ: Guaranteed Issue for Medicare Supplement

The following are descriptions of seven other scenarios that may cause a client to qualify for guaranteed issue rights, including the timeline for each circumstance.

1. A beneficiary is in a Medicare Advantage (MA) plan, and their plan is leaving Medicare, stops giving care in the beneficiary's area, or if they move out of their plan's coverage area. With this guaranteed issue right circumstance, a beneficiary can apply up to 60 calendar days before the date their health care coverage ends, and no later than 63 days after their coverage ends.
2. The beneficiary has original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays, and this coverage had ended. The beneficiary must apply for a Medicare supplement policy no later than 63 calendar days after the latest day that the coverage ends, the date on the notice they get telling them that the coverage is ending, and the date on the claim denial (if this is the only way they know that their coverage has ended).
3. The client has original Medicare and a Medicare SELECT policy, and they move out of the Medicare SELECT policy's area. The beneficiary can keep their Medicare supplement policy, or move to another MedSupp policy. If they choose to move, they can apply up to 60 calendar days before, but no later than 63 days after, the date their health care coverage ends.
4. If a beneficiary joined an MA plan or PACE when they were first eligible at age 65, and within the first year of joining they decide they want to switch to original Medicare, they can apply for a Medigap policy up to 60 days before but no later than 63 days after their coverage ends.
5. A client previously dropped a MedSupp policy to join an MA plan or to switch to a Medicare SELECT policy for the first time, and they have been in the plan for less than a year but they decide they want to switch back. They can apply up to 60 calendar days before but no later than 63 days after their coverage ends.
6. The customer's Medigap insurance company goes bankrupt and the client loses their coverage, or if the Medigap policy coverage ends through no fault of the beneficiary. They must apply no later than 63 days after their coverage ends.
7. If a beneficiary leaves an MA plan or drops a Medigap policy because the company didn't follow the rules or because the company misled the beneficiary, the client must apply no later than 63 days after their coverage ends.

For more information on Medicare supplement and guaranteed issue, see the 2010 "Choosing a Medigap" guide.

Tim Fields, an agent from Maryland, assisted ASJ in compiling this answer.

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