If you are in a Medicare Advantage (MA) plan, you have guaranteed-issue rights to buy a Medigap policy in certain situations. These rights require private insurers to sell you a policy without a health screening. You cannot be denied a policy or charged a higher premium due to your current health or history.
You have guaranteed-issue rights to a Medigap policy when:
- Your Medicare Advantage (MA) plan terminates coverage. In this case, you can return to Original fee-for-service Medicare with Medigap, but you must apply within 123 days of the end of your MA plan benefits.
- You move outside your MA plan service area. You must apply within 63 days of moving.
- You joined an MA plan when you first became eligible for Medicare and want to switch to a Medigap policy during your first 12 months in the MA plan. This is your Medicare Trial Period #1.
- You switch from a Medigap policy to an MA plan for the first time since becoming eligible for Medicare, and you disenroll from the MA plan within the first 12 months. This is your Medicare Trial Period #2.
If you are switching from an MA plan to a Medigap policy and do not fall into one of the categories above, Medigap companies are not required to sell you a policy.
Important Tips When Applying for a Guaranteed-Issue Medigap Policy
- If your MA plan stops providing benefits in your area and you want to return to Original fee-for-service Medicare, but you have a health condition that may make it difficult to get Medigap coverage, do not disenroll from your MA plan until you receive a final notice of termination. This notice should be sent in the beginning of October. If you disenroll before receiving the termination notice, you may lose your guaranteed-issue right to purchase a Medigap policy without a health screening.
- Use your MA plan's final termination notice to apply for 1 of the 6 guaranteed-issue Medigap policies — A, B, C, F (with or without the high deductible option), K or L. You must keep a copy of the MA plan's final notice as proof that the plan is terminating your coverage.
- You have a period of 123 days to apply for one of the guaranteed-issue Medigap policies, beginning on December 31, when your MA plan benefits automatically end. To avoid any gaps in coverage, you can arrange ahead of time to have your Medigap benefits begin January 1 (you can do this at any point after you are notified of the change to your plan in early October). If you do not arrange for a Medigap policy to begin January 1, you will not have any supplemental Medicare insurance until you choose a policy. If you exceed the 123 days to apply for a guaranteed-issue Medigap policy, you may be required to have a health screening. In addition, companies may charge you a higher premium or refuse to sell you a Medigap policy due to health conditions.
Learn more about your rights to buy a Medigap policy.