Medicare Guaranteed Issue Rights by State

By Daniel Petkevich

Feb 10, 2023

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Guaranteed Issue Rights in some States Are More Favorable than Others

What Are Guaranteed Issue Rights?

• Are legally obligated to sell you a Medicare Supplement (Medigap) policy
• Cannot reject your application
• Must cover all your pre-existing conditions
• Cannot overcharge you due to a pre-existing condition

When Do You Have Guaranteed Issue Rights?

1. If you're enrolled in a

   Medicare Advantage plan

   and:
   1. It will no longer be part of Medicare
   2. It's discontinuing its service in your region, or
   3. You move outside of your plan's service area
2. When your employer group health plan or union coverage that supplements Original Medicare is ending
3. If you have a

   Medicare SELECT

   plan and you decide to move out of its service area
4. When your Medigap Insurance company goes bankrupt, or your plan coverage ends through no fault of your own
5. If you leave a Medicare Advantage Plan or a Medigap plan because your insurance company didn't follow the rules or misled you

1. If you enrolled in a Medicare Advantage plan or

   PACE (Program of All-inclusive Care for the Elderly)

   during your

   Initial Enrollment Period

   and within the first year decide to return to Original Medicare
2. If you dropped a Medigap plan to enroll in a Medicare Advantage plan (or Medicare SELECT plan) for the first time and, within the first year and decide to switch back

What Happens if Your Medicare Supplement Plan Discontinues Your Coverage?

• You can choose a Medigap plan* sold by any insurance provider in your state
• You can apply for a Medicare Supplement (Medigap) plan starting 60 days before your coverage ends until 63 days after your coverage has expired

• A disenrollment letter from your insurance company
• The date your coverage ends
• Your name (or the applicant's name) on the documentation

What Happens if Your Employer Plan Ends?

• The end of your coverage
• The date of the notification informing you of the coverage termination (if received)
• The date of a denied claim, if it was the only way to determine coverage termination

• Copies of any letters, notices, emails, or claim denials that include your name as evidence of your coverage termination
• The postmarked envelope these documents came in as proof of the mailing date

If You Voluntarily Lose Your Group Coverage

• The date the coverage ends
• Documentation from your employer or carrier on their letterhead
• Information about whether the coverage was primary or secondary

What Happens if Your Insurance Provider Misleads You?

How Do Medicare Guaranteed Issue Rights Differ by State?

1. Annual or Continuous Guaranteed Issue Rights

2. Voluntary group termination

• Alaska
• Arkansas
• California
• Colorado
• Florida
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Louisiana
• Maine
• Missouri
• Montana
• Nevada
• New Jersey
• New Mexico
• Ohio
• Oklahoma
• Pennsylvania
• South Dakota
• Texas
• Virginia
• West Virginia
• Wisconsin

3. Annual or Continuous Open Enrollment Period

• Connecticut
• New York
• Vermont — only for Mutual of Omaha and UnitedHealthcare plans
• Maine — Offers Open Enrollment annually in June. You can switch to a similar or lower-benefit plan without medical underwriting during this period

What Documents Do You Need When Using Your Guaranteed Issue Rights?

• A copy of your current Medicare Supplement ID card with your current plan letter and your name
• Proof of payment for the last three months that includes your full name

• Proof of disenrollment
• The policy end date

Stay up-to-date with Your State Regulations to Optimize Your Medicare Benefits