Your Rights When Buying a Medigap Policy

"Guaranteed Issue Rights" protect anyone eligible for a Medigap Policy. These rights require that every private insurance company that provides Medicare policies must adhere to strict rules and regulations. During your 7-month Open Enrollment Period you have these Guaranteed Issue Rights. Currently there is only one exception to this rule. If you have not had creditable coverage during the previous six months the Medigap insurance company can delay the start of your policy. Other than this you will have the right to:

  • Buy a Medigap policy.
  • Buy a policy even if you have a pre-existing condition.
  • The price cannot be influenced by current or previous medical history.

Outside of Initial Open Enrollment, When do I have Guaranteed Issue Rights?

Guaranteed Issue Rights are also given to Medicare patients at other times. A good way to think about this is that you will have Guaranteed Issue Rights whenever your insurance is affected by circumstances beyond your control.

For example, if your Medigap Company leaves Medicare or you move out of the service plan's area you will have the right to buy another policy.

Generally, if you decide to leave a Medicare Advantage Plan you will have two months during which time you have Guaranteed Issue Rights to buy a Medigap policy.

Anyone who had a Medigap policy, switches to a Medicare Advantage Plan and then wants to switch back, may repurchase the same Medigap policy they had before. Sometimes the previous plan is not available, in which case they may buy a new Medigap policy. However, it may not be possible to repurchase drug coverage.

The One-Year Trial Period

Within one year of signing up for Medicare Advantage or PACE you can also switch to original Medicare/Medigap if your are unhappy with your coverage. This is known as your Trial Right. During this one-year period you have guaranteed issue rights to buy a new Medigap Advantage Plan.

Retirees who have Cobra or retiree health plans also have the right to buy Medigap insurance if their company coverage ends.

Medicare SELECT policyholders who move to a new area still have the right to purchase a different Medigap policy if they want to.

The Grey Area Related to Medigap Rights

The last set of circumstances in which you have Guaranteed Issue Rights is if your Medigap Company hasn't followed Medicare's rules or has misled you in any way. It is always important to keep all written correspondence (with the postmarked envelope) and documentation related to medical insurance so that you have proof if you need it in the future.

Auntie Lou says, "An old box will do- just throw the papers in there and keep them in the basement in case you need them!"

It's important to know you have protected rights under Medicare related to your Medigap policy. However, your rights are also limited by time frames. These limitations are enforced and are used to remove your Guaranteed Issue Rights. Pay attention to them any time you are acquiring or changing a Medigap policy.