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HOW CAN I GET MEDIGAP OUTSIDE OF OPEN ENROLLMENT?

You can get Medicare Supplement insurance outside of an open enrollment period if you qualify for certain guaranteed issue rights. Read more to learn if you qualify for guaranteed issue Medigap.

Medigap plans (also called Medicare Supplements) are a solution to the gaps left behind by Original Medicare (Parts A and B). Medigap plans provide more comprehensive coverage than Original Medicare. In other words, they reduce or eliminate your out-of-pocket costs in exchange for a monthly premium (similar to traditional healthcare coverage).

Medicare Supplements are best purchased during the Initial Enrollment Period (IEP). This is a special period of time when you can purchase any plan you see fit without being subject to underwriting — the process in which an insurance company looks at your health and history to determine your overall risk (how likely and how often you’ll be using your coverage and subsequently costing the company money).

Based on the results of the underwriting process and your medical history and conditions, an insurance company has a right to deny you coverage, charge you a higher premium, or make you wait until your coverage kicks in.

For many, it’s impossible to qualify for or afford a Medigap plan if health conditions are taken into account. This is why choosing the right plan is so important during your IEP, when underwriting is not a factor.

However, you may have a guaranteed issue right to purchase a Medicare Supplement outside of an enrollment period — without undergoing the underwriting process.

WHAT ARE GUARANTEED ISSUE RIGHTS?

Guaranteed issue rights, also called Medigap protections, define situations in which insurance companies must offer certain Medicare Supplements to you in the same way they would during your IEP. That is, no underwriting and no chance they’ll deny you coverage.

When you qualify for guaranteed issue rights, insurance companies:

Federal law guarantees issue rights (see how that works out?!). So insurance companies can’t skirt around your eligibility for a Medigap plan if you’re entitled to these rights — no ands, ifs, or buts.

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WHEN DO YOU QUALIFY FOR GUARANTEED ISSUE MEDIGAP?

There’s no enrollment period to qualify for guaranteed issue rights to purchase a Medigap policy. Instead, these rights are triggered when certain events occur that would otherwise leave you without healthcare coverage through no fault of your own. For example, you wouldn’t qualify for guaranteed issue rights if you simply decide to stop paying your premium.

Click the links to below to jump to a scenario that fits your needs, or keep reading to learn more.


1. Your Medicare Advantage Plan Leaves Medicare, Changes Service Areas, or You Move From the Service Area

If you have a Medicare Advantage plan (Part C of Medicare), you qualify for guaranteed issue rights if:

You may apply for a Medigap plan up to 60 days before or 63 days after you lose coverage. Coverage under your Medigap plan would not begin until your Medicare Advantage coverage has ended, however.

You will not have guaranteed issue rights to switch to another Medicare Advantage plan. Instead, you must switch back to Original Medicare. This will then make you eligible for any A, B, C, F, K, or L Medigap plans offered in your state.

2. You Have Original Medicare and Group Coverage, and Your Group Coverage is Ending

If you lose healthcare coverage that pays after Original Medicare — such as employer coverage, COBRA, or retiree coverage — you have guaranteed issue rights to Medigap plans A, B, C, F, K, and L.

You qualify for guaranteed issue rights 63 days after the latest of: