Questions About Open Enrollment vs. Guaranteed Issue Rights?

Medicare Open Enrollment vs Guaranteed Issue Rights
Medicare Supplements (Medigap policies) have two different types of enrollment periods that don’t require you to answer health (medical) questions.  These different periods of time are called a few different names which can be obscure.  Here is a break down to better understand the different terms and their specific rules.

Medicare Supplement (Medigap) Open Enrollment
This period is considered your “initial enrollment period”.  Thus the reason it is called your “initial enrollment period” is that many confuse the Medigap Open Enrollment period with the Medicare Open Enrollment period.  Medicare Open Enrollment permits someone to change their Medicare Drug or Medicare Advantage plan each year, whereas Medigap’s Open Enrollment normally only allows you ONE guaranteed enrollment period, regardless of preexisting conditions.This period lasts six months and begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B. So if you turn 65 on April 3 but don’t join Medicare B until May 25, your Medigap Open Enrollment Period will start on June 1, which is the first day of the month in which you are both 65 and enrolled in Part B.  (Some States such as CA, have a 30 day Medigap Birthday rule that allows you to switch Medigap plans to an equal or lesser value than your current Medigap plan during your birth month-without answering health questions).

Medigap Guaranteed Issue Rights
The chart below describes the situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it.  States may provide additional Medigap guaranteed issue rights.

You have a guaranteed issue right if…	You have the right to buy…	You can/must apply for a Medigap policy…
​You’re in a Medicare Advantage Plan (like an HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area.	Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company. You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.	​As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.
You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.   Note: In this situation, you may have additional rights under state law.	Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company. If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.	No later than 63 calendar days after the latest of these three dates: 1. Date the coverage ends 2. Date on the notice you get telling you that coverage is ending (if you get one) 3. Date on a claim denial, if this is the only way you know that your coverage ended.
You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area. Call the Medicare SELECT insurer for more information about your options.	Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state or the state you’re moving to.	​As early as 60 calendar days before the date your Medicare SELECT coverage will end, but no later than 63 calendar days after your Medicare SELECT coverage ends.
(Trial right) You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.	Any Medigap policy that’s sold in your state by any insurance company.	As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.   Note: Your rights may last for an extra 12 months under certain circumstances.
(Trial right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back.	The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If your former Medigap policy isn’t available, you can buy Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.	As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.   Note: Your rights may last for an extra 12 months under certain circumstances.
Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.	Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company. Medigap.	No later than 63 calendar days from the date your coverage ends.
You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.	Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.	​No later than 63 calendar days from the date your coverage ends.

Source: 2017 Choosing A Medigap Policy

By Cassandra Bennett