Guaranteed Issue Rights with Medicare and Medicare Supplements by State

There are only certain situations when you can enroll in a Medicare Supplement (Medigap) policy without answering underwriting health questions. One instance is when you are using guaranteed issue rights. If you have these protections, it is important to apply for a Medigap policy to guarantee acceptance to the plan.

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Below, we break down how guaranteed issue rights work according to different scenarios and everything you need to know if you face losing coverage.

What Are Medicare Supplement Guaranteed Issue Rights?

Also known as Medigap protections, guaranteed issue rights prohibit insurance companies from denying coverage or overcharging you for a Medigap policy, regardless of pre-existing health conditions. By law, all beneficiaries are protected from unfair medical underwriting, and these protections exist to oversee this. Thus, it is important to understand all your Medicare Supplement rights and protections.

There are a handful of instances in which you are eligible to use guaranteed issue rights. They usually occur when you lose coverage for reasons beyond your control, if you use a trial right, or because you move out of your policy’s coverage area.

Scenarios That Grant You Guaranteed Issue Rights:

  • You leave a Medigap policy to join a Medicare Advantage plan for the first time, have been in the plan less than a year, and wish to go back to Medigap (Trial Right)
  • You joined a Medicare Advantage Plan at age 65 and want to switch to Medigap during the first year (Trial Right)
  • Your Medicare Advantage plan is dropping coverage in your area, or you move out of the plan service area
  • You have Medicare SELECT and decide to move out of the plan’s service area
  • Your employer plan that supplements Medicare ends
  • The Medicare company did not follow the rules or misled you
  • Your Medigap insurance company goes bankrupt

What If My Medicare Advantage Plan Suspends My Coverage?

If the company you are currently insured with is discontinuing your coverage, you need the following information to qualify for a plan change:

  • A dis-enrollment letter from your insurance provider
  • The date your coverage ends
  • The applicant’s name on the documentation

Once you qualify, you can select a Medigap policy and avoid the health questions, guaranteeing coverage.

What If My Employer Plan That Supplements Medicare is Ending?

You can apply for Medigap starting 60 days before you lose coverage, and your guaranteed issue right ends 63 days after you lose coverage. If an employer plan ends, you must apply for Medigap no later than 63 days following the loss of coverage.

Those with COBRA can either wait until COBRA ends or buy a Medicare Supplement (Medigap) plan right away.

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What If I Involuntarily Lose Group Coverage?

If you involuntarily lose group coverage, this means your insurer is dropping your plan. This also includes if the insurance company files for bankruptcy.

Involuntary means you did not cancel the coverage, nor are you losing coverage for non-payment. If you are losing group coverage involuntarily, you may qualify for guaranteed issue supplemental insurance.

What If I’m Voluntarily Losing Group Coverage?

If you are voluntarily losing group coverage, you choose to leave your carrier. When you talk to an agent, you should be ready to send the following information to the insurance company:

  • The date that the coverage ends
  • Documentation on your employer or carrier letterhead
  • Indication of whether the coverage is primary or secondary

What If My Medicare Carrier Didn’t Follow the Rules?

If a company misleads you or does not follow the rules, you may qualify for guaranteed issue rights for a new policy. However, you may need to file a complaint with Medicare.

Medigap Guaranteed Issue Rights by State

Certain states have special guaranteed issue rights that impact their policyholders. Each of these state-specific rules allows beneficiaries an opportunity to change Medigap plans without underwriting.
When utilizing these state-specific guaranteed issue rights, it is essential to provide the necessary documentation for a smooth transition.

You will need the following documents for a Supplement-to-Supplement policy change:

  • A copy of your current Medicare Supplement ID card with your current plan letter and your name
  • Proof of payment for the past three months, which must include your full name

You will need the following documents for an Advantage-to-Supplement policy change:

  • Proof of disenrollment
  • The date your policy ends

If you have no coverage through a Medicare Supplement or Medicare Advantage plan, you may require medical underwriting.

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Guaranteed Issue Rights with Loss of Medicaid

Advantage guidelines for guaranteed issue rights do not apply to Supplements. So, if you lose Medicaid, you may or may not qualify for guaranteed acceptance in a Supplement, depending on your state. If under 65, waiting until your 65th birthday month for the Medicare Supplement Open Enrollment Period is possible.

When you apply for new coverage, you will need:

  • Your Medicaid termination letter
  • The date that coverage ends/ended
  • An applicant’s name on the document

Which Medicare Supplement Plans are Guaranteed Issue?

The plans you’re eligible to use guaranteed issue rights with depending on the date your eligibility began. When utilizing guaranteed issue rights, beneficiaries are required to follow MACRA. This means that only those who were enrolled in Medicare prior to January 1, 2020 are only eligible for a guaranteed issue Medicare Supplement Plan F or Plan C. Conversely, those who enrolled in Medicare after January 1, 2020 can enroll in any plan other than Plan F or Plan C.

How to Get Help Understanding Guaranteed Issue Rights

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

26 thoughts on “Guaranteed Issue Rights with Medicare and Medicare Supplements by State

  1. Is there an addendum or a recent notice for a guaranteed right to buy a Medicare supplement insurance plan at the time of a birthday month this year?


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