In addition to the consumer protections provided by open enrollment, people in certain situations have Guaranteed Issue. Guaranteed Issue is the status of a person to whom an insurance company is required to offer a Medigap policy. Under Guaranteed Issue, the policy issued must cover pre-existing conditions without medical underwriting or a waiting period.
Those who qualify for Guaranteed Issue include:
Those losing a Medicare Advantage (Part C) plan: if you’re losing a Medicare Advantage plan due to that plan leaving Medicare or discontinuing coverage in your location, you have Guaranteed Issue. This only applies if you switch to Original Medicare.
Your employer or union group health plan is ending: If your employer or union group health plan was designed to pay after Medicare pays, but it is ending, you have Guaranteed Issue.
You have Original Medicare and Medicare Select but are moving: You are allowed to keep your old Medicare Select policy even though you are moving, or you may elect to look for a policy from another company in your state. You have Guaranteed Issue if you elect to do the latter.
Your Medigap Insurance coverage ends through no fault of your own: This could happen if the company goes bankrupt.
You have to leave a Medicare Advantage or Medicare Supplement plan because the company has misled you or broken rules: If your company misleads you or fails to meet federal and state standards of care, you may be able to switch companies with Guaranteed Issue rights.
You are in a trial period: In some circumstances, if you joined a Medicare Advantage or a Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare but you are unhappy with it within the first year of coverage, you may be able to switch to a Medigap policy. If you dropped a Medigap policy in favor of an Advantage Plan or a Select plan but you want to switch back to traditional Medigap within a year, you may also have Guaranteed Issue under a trial period.
For each of the above circumstances, a unique set of time requirements applies. In some cases, you’ll only be able to purchase a limited range of plans, but in other circumstances, all local plans will be available to you. To fully understand how long your guaranteed issue will last and what plans you can purchase, you can learn about your rights on the official Medicare website.