There are certain “Guaranteed Issue” periods which are allotted to Medicare supplement plans. This enables individuals to apply for a plan without being denied coverage, regardless of their previous conditions, or being charged more because of any health conditions. Rights for guarantee issue (GI) period have federal mandates from the Centers for Medicare & Medicaid Services and apply to every Medicare-enrollee who falls into the category of one of these specific situations.
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Generally speaking, the GI rights occur when the health care coverage you currently have is being modified in a certain way or you are losing your coverage involuntarily. Certain insurance companies may develop their own GI situations—and they sometimes do so.
However, all Medicare Supplement insurance companies must as a matter of fact follow seven federally prescribed GI situations. You or any individual should be able to enroll for a Medicare Supplement plan on a Guaranteed Issue basis if you fall into one of these periods. These seven federally prescribed GI situations are:
- You signed up for a Medicare Advantage PACE or plan when you first qualified to enroll, and within one year of enrolment, you decide to switch back to the original Medicare Supplement plan.
- You signed up for a Medicare Advantage plan, and this plan stopped servicing your area, is leaving the Medicare program, or you are moving out of the specific service area covered by the plan.
- You have a union coverage or an employer that pays AFTER Medicare, and that coverage will soon end.
- You do have a Medicare SELECT policy, and you are relocating from the service area covered by the plan. You can maintain your current policy, but you have the right to switch to a new policy on a GI basis.
- Your Medicare Supplement company has gone bankrupt, and this causes you to lose coverage, or through no fault of yours you lose Medicare Supplement plan coverage.
- You left a Medicare Supplement plan to switch to a Medicare SELECT or Medicare Advantage policy for the first time. The plan has been running for less than a year now and you wish to switch back to a Medigap policy.
- You took a decision to sign off a Medicare Advantage plan or leave a Medigap policy because the provider did not follow the rules or has misled you in some way.
States also have the legal authority to create extra GI situations, and some States have actually done so. Some of the specific GI situations also have specific requirements for the plans that you can sign up for. For instance, in the case of a Medicare Supplement plan, you may qualify for a GI; however, it may have to be one of the recognized plans.
If you are on a Medicare, it is beneficial for you to be aware of these guaranteed issue situations. If you are eligible for one of them and you decide not to enroll for a plan while that GI period is in effect, it is most likely that if you decide later on to sign up, you will have to qualify medically for a Medicare Supplem