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Getting Medigap On
Guaranteed Issue

In addition to the initial Open Enrollment period, there are also certain times called Special Election Periods when Medicare requires that all companies issue coverage for Medicare Supplements on a guaranteed-issue basis.  That means that there can be no health questions to disqualify you from coverage, and an insurance company cannot refuse to sell you a Medigap or Medicare Supplement policy in those situations.

The most common of these events is when a person loses other creditable health coverage due to employment and/or group health insurance ending.  In those situations, you would need to complete an application and include documentation (usually a letter from the employer or insurance company) stating the start date and end date of your group plan.  Insurance companies can also accept letters to the group health company requesting coverage to end due to retirement or termination of employment.  Generally, you need to apply no later than 63 calendar days from the time your other coverage ends.

You can also receive a guaranteed-issue period if the plan that covers you goes bankrupt or otherwise ceases operation in your state.  To receive guaranteed-issue status, you would still need to apply no later than 63 days from the time your other coverage ends.

Another general provision is known as Trial Right.  If you join a Medicare Advantage plan when you are first eligible or drop a Medicare Supplement plan to buy a Medicare Advantage plan for the first time, you can change back to a Medicare Supplement on a guaranteed-issue basis as long as you switch back in 12 months or less.  After keeping the Medicare Advantage plan for more than 12 months, your guaranteed-issue option is no longer available to you.

These provisions are covered in detail in each year’s Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare, developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC).

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