During guaranteed-issue periods, companies must sell you one of the required Medigap policies at the best price for your age, without a waiting period or health screening. Guaranteed-issue periods are generally shorter than open enrollment periods and do not include as many choices.
You can usually apply for a guaranteed-issued Medigap policy as early as 60 days before your current benefits end to avoid a gap in coverage. In most cases, you must also apply for one of these plans no later than 63 days after your coverage ends as a result of one of the events described below. When you submit your application, you are typically required to provide evidence of the date your coverage ends or ended.
You have the right to purchase certain Medigap plans following the 7 events listed below, which apply to Medicare beneficiaries of all ages. For most of the events, you are only guaranteed the right to buy plans A, B, C, F, K or L.
1. Termination of Employer-Sponsored Retiree Plan
You have the right to purchase certain Medigap plans when your employer-sponsored retiree plan (including COBRA coverage) that is supplementing Medicare involuntarily terminates. This federal right does not apply if the terminating health plan provided primary benefits or if you stopped paying your premium for the retiree plan or COBRA coverage. California law is broader and provides more protection for its residents in this situation.
2. Reduction of Employer-Sponsored Retiree Benefits or Loss of Eligibility
You have the right to purchase certain Medigap plans if your employer-sponsored retiree plan stops providing supplemental benefits to Medicare, but continues providing other benefits, or if you lose eligibility due to divorce or death of a spouse or family member.
3. Changes to Medicare Advantage (MA) Plan
You have the right to purchase certain Medigap plans if your Medicare Advantage (MA) plan increases your costs, reduces your benefits or a medical provider treating you leaves the plan. In these situations, you can only buy a Medigap plan from the company that offers your MA plan, its parent company or a network that contracts with the MA plan.
You can only exercise this right if the changes described above occur during the times you are permitted to disenroll from your MA plan:
- Annual Election Period (AEP): November 15 to December 31 of each year with an effective disenrollment date of January 1 the following year.
- MA Open Enrollment Period (OEP): January 1 to March 31 of each year with an effective disenrollment date of the first day of the month following your request.
If your MA plan increases costs or reduces benefits (which usually occurs at the end of the plan year and coincides with the federal AEP), the plan is required to send you notice. A provider may leave or be dropped from your MA plan anytime during the year.
4. Moving Out of Medicare Advantage (MA) Plan or PACE Organization Service Area
You have the right to purchase certain Medigap plans if you move out of the area of your Medicare Advantage (MA) plan or Program for All-Inclusive Care for the Elderly (PACE) organization. You have the right to buy a Medigap policy even when MA plans and PACE organizations are available in your new area.
5. Medicare Plan Fraud, Loss of Contract, Misrepresentation or Failure to Meet Contractual Obligations
You have the right to purchase certain Medigap plans if your Medicare Advantage (MA) plan, Medicare SELECT Plan, PACE provider or any other health plan under contract with Medicare:
- Commits fraud
- Ends or loses its contract with Medicare
- Misrepresents the plan you bought
- Has failed to meet its contractual obligations to Medicare beneficiaries, as determined by the federal government
6. Medicare Trial Period #1
You have the right to purchase certain Medigap plans during Medicare Trial Period #1: You joined a Medicare Advantage (MA) plan or Program for All-Inclusive Care for the Elderly (PACE) organization when you first became eligible for Medicare at age 65, and you want to switch to a Medigap policy during your first 12 months in the MA plan or PACE organization.
Note: If you were previously in an MA plan or PACE organization, you are not eligible for this guaranteed-issue right.
7. Medicare Trial Period #2
You have the right to purchase certain Medigap plans during Medicare Trial Period #2: You switch from a Medigap policy to an MA plan, PACE organization, Medicare SELECT plan, or any other health care organization contracting with Medicare, for the first time since becoming eligible for Medicare, and you disenroll from that plan within the first 12 months. You have the option to return to your previous Medigap policy if it is still available. If it is not available, you can choose plans A, B, C, F, K or L from any company.
Note: If you were previously in an MA plan, PACE organization, Medicare SELECT plan or any other health care organization contracting with Medicare, you are not eligible for this guaranteed-issue right.
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