Medicare Supplement Open Enrollment & Guaranteed Issue Rights

When it comes to Medicare Supplement policies there are times and situations when your client has the right to enroll in a Medigap plan without answering any health questions. The most important of those times being during their six month Medigap Open Enrollment period. This occurs when your client turns 65 or when they first enroll in Medicare Part B. 

​​However, there may be times when you have a client who wants to enroll in a Medicare Supplement and they fall outside of their Open Enrollment period. Perhaps you have a client who's moving and they want to switch plans. ​Or you might have a client who was enrolled in a Medicare Advantage plan and they want to make the switch to a Medicare Supplement. Regardless of the situation, there may be Guaranteed Issue or Trial right available, allowing them to enroll in a Medigap plan without answering health questions. 

Examples of Guaranteed Issue & Trial Rights:

• Your client is in a Medicare Advantage Plan, and the plan is leaving Medicare or stops giving care in their area, or your client moves out of the plan’s service area.
• Your client has 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, your client may have additional rights under state law.
• Your client has Original Medicare and a Medicare SELECT policy. If your client moves out of the Medicare SELECT policy’s service area. Call the Medicare SELECT insurer for more information about their options.
• Your client joined a Medicare Advantage plan or Programs of All-inclusive
  Care for the Elderly (PACE) when they were first eligible for Medicare Part A at 65, and within the first year of joining they decided they wanted to switch to Original
  Medicare. This is called a trial right.
• Your client dropped a Med Supp policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, and they've been in the plan less than a year, and want to switch back. Again, this is a trial right.
• Your client's Medicare Supplement carrier goes bankrupt and they lose coverage, or their Medigap policy coverage otherwise ends through no fault of their own.
• Your client leaves a Medicare Advantage Plan or drops a Medigap policy because the company hasn’t followed the rules, or misled your client.

Example: same client - different situations

Year-round Enrollment & Other Rules

​​​If your client doesn't fall under any of the Guaranteed Issue/Trial Right situations listed above, there are certain states that have year-round open enrollment periods. There are also states that have birthday and anniversary rules which allow your client to switch plans without going through underwriting. Each state has its own regulations and guidelines so it's important to familiarize yourself with them before enrolling your client in a Medicare Supplement plan. ​

State	Rule
California	Your client can change their Medicare Supplement policy during the month of their birthday without underwriting. They must have an existing policy in place to qualify though.
Connecticut	​Connecticut has a Medicare Supplement Open Enrollment period year-round and has specific rules regarding enrollment.
Idah	​In Idaho your client may switch to a different Medicare Supplement plan of equal or lesser coverage and this window begins on their birthday and ends 63 days after.
Illinois	​Clients aged 65 to 75 years old have 45 days after their birthday to change their Medicare Supplement policy without underwriting. They can only purchase a policy with equal or lesser coverage from their current policy.
Louisiana	Any client who is at least 65 years of age can switch to another Medicare Supplement policy without answering health questions and may do so up to 45 days after their birthday.
Maine	Year-round open enrollment period occurs in Maine and your client can switch to another Medicare Supplement plan with equal or lesser benefits.
Maryland	Your client can change their Medicare Supplement policy during the month of their birthday without underwriting. They must have an existing policy in place to qualify though.
Massachusetts	​Massachusetts offers year-round open enrollment and an additional guaranteed issue window between February 1st - March 31st that enrollees can use to change their Medicare Supplement policies without underwriting.
Missouri	Your client can switch insurance carriers, while keeping the same level of coverage, during the months surrounding their Medigap anniversary. The window to make this change begins 30 days before the issue date of your client's existing Medicare Supplement policy and lasts until 30 days after the issue date. As for the level of coverage, they can switch from a Plan G to a Plan G without underwriting, but not from a Plan G to a Plan N, for example.
Nevada	​In Nevada your client may change their plan to a different plan that has equal or lesser coverage without underwriting. This window occurs on the 1st day of their birthday month and lasts for 60 days.
New York	New York state has a year-round Medicare Supplement Open Enrollment period with specific rules regarding enrollment.
Oklahoma	Your client may switch to another Medicare Supplement plan of equal or lesser value and has a 60 day window that starts on their birthday.
Oregon	Your client can change their Medicare Supplement policy during the month of their birthday without underwriting. They must have an existing policy in place to qualify though.
Vermont	Vermont has a Medigap Open Enrollment period year-round with specific rules regarding enrollment for applicants.
​Washington	If your client has a Plan A, they can only switch to another Plan A without underwriting. However, if they have ANY other Medicare Supplement plan, they may switch to any other Medicare Supplement plan without underwriting.

If your client falls outside of their open enrollment period, doesn't live in a state with year-round open enrollment and doesn't qualify for guaranteed issue rights, they will likely have to go through underwriting; and that requires answering medical and pharmaceutical questions on the application as well as during a phone interview.

If you have any questions regarding Guaranteed Issue rights, birthday rules or getting your client through underwriting, please reach out to us and we'll be happy to assist you. Additionally, feel free to download our Medicare Enrollment Periods guide.

By Carolyn Portanova

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