Medicare Supplement User Rights: Open Enrollment vs. Guaranteed Issue
When you can purchase a Medicare Supplement is a question I often receive. If you do not enroll at the correct time it could cost you the opportunity to enroll at all. It is important to understand the difference between Open Enrollment and Guaranteed Issue.
Medicare Supplement Open Enrollment
Every Medicare recipient has what’s known as a Medicare Supplement Open Enrollment Period. This lasts for six months and starts on the first day of the month when you’re at least 65 years old and enrolled in Medicare Part B. Because the start of this six-month period requires you to enroll in Part B, the timing might differ from your Medicare initial enrollment period, which begins three months before your 65th birthday and last until three months after.
During your Medicare Supplement Open Enrollment Period, you’re able to purchase any Medigap policy that’s available in your state. The 10 standardized Medigap policies are available in 47 states, with Massachusetts, Minnesota, and Wisconsin offering slightly different options.
The benefits of buying a Medigap plan during open enrollment are twofold. Not only do insurance companies have to sell you any policy that’s available in your state but they also have to charge you a standard rate. That means providers can’t require you to pay more due to your age or a pre-existing condition.
Not everyone chooses the right Medigap plan on the first attempt. If you want to purchase the same plan from a different provider or you want to change the plan entirely, you can apply for a new plan at any point during the year. If this occurs outside your initial period, you will have to answer health questions to qualify for coverage.
Medicare Supplement Insurance Guaranteed Issue
Certain situations can occur that cause you to have what’s known as a guaranteed issue right. These rights ensure that you can get the health care coverage you need. When your guaranteed issue rights are in effect, providers have to:
- Sell you a Medigap plan
- Cover your pre-existing health issues, no matter what they are.
- Charge you the standard Medigap plan rate, even if you have pre-existing conditions.
Guaranteed issue rights apply to several situations. You can exercise your rights in the following scenarios:
- You have both Medicare and an employer-sponsored group health plan, and the latter is ending. Meaning you stayed employed past 65
- You purchased a Medicare Advantage Plan that’s leaving Medicare or stops covering your geographical area.
- You stopped your Medigap policy to switch to a Medicare Advantage Plan. Less than a year has passed, and you want to switch back to Original Medicare and Medigap.
Your Medicare Supplement Insurance company goes bankrupt or otherwise stops your coverage at no fault of your own.
Can You Purchase Medicare Supplement Insurance At Other Times?
You might be able to purchase a Medigap policy outside of your open enrollment period and when you don’t have guaranteed issue rights. This depends entirely on your health status and the insurance company you choose.
If you don’t have an open enrollment period or guaranteed issue rights, insurance companies may use medical underwriting to determine whether to take your application or grant you a policy.
Different Medicare Supplement insurance carriers have different underwriting standards. If you are denied coverage by one carrier, you may still be eligible for coverage with a different one. This is a situation where having an independent agent is huge since they can help you apply for coverage with a variety of Medigap insurance carriers.
For some retirees, it’s worth the effort to purchase a Medigap policy after the open enrollment period and outside of any special conditions. If you’re faced with this decision, take the time to compare the premium costs with your anticipated medical bills. With this calculation in hand, you can make the right choice for your budget, health care needs, and peace of mind.
Navigating Medicare options isn’t easy, especially when you want to secure the most complete coverage possible. Visit our site often to stay up to date on Medigap policies, Medicare changes, and other essential coverage details. Or call us at 800-708-5810 for free no obligation advice.