Guaranteed Issue

In addition to the open-enrollment period, in some situations you have the right to enroll in a Medicare supplement or Medicare select policy regardless of your health status if your other health coverage terminates. The insurance company must offer you one of these Medigap policies if:

  • Your Medicare Advantage or Medicare cost plan stops participating in Medicare or providing care in your service area; or
  • You move outside the plan's geographic service area; or
  • You leave the health plan because it failed to meet its contract obligations to you; or
  • Your employer group health plan ends some or all of your coverage; or
  • Your Medicare supplemental insurance company ends your Medigap or Medicare select policy, and you are not at fault (for example, the company goes bankrupt); or
  • You drop your Medigap policy to join a Medicare Advantage plan, a Medicare cost plan, or buy a Medicare select policy for the first time, and then leave the plan or policy within one year after joining. However, you may only return the policy under which you were originally covered, if available; or
  • You have Medicare Parts A and B and are covered under Medical Assistance and lose eligibility in Medical Assistance.

When you meet the above conditions and you apply for your new Medigap policy no later than 63 calendar days after your health plan or policy coverage ends, the Medigap insurance company:

  • Cannot deny you insurance coverage or place conditions on the policy (such as a waiting period),
  • Must cover you for all preexisting conditions, and
  • Cannot charge you more for a policy because of past or present health problems.

The insurance company terminating coverage must provide a notification that explains individual rights to guaranteed issue of Medigap plans. You must submit a copy of this notice (creditable coverage) or other evidence of termination with the application for the new policy.