What Is Guaranteed Issue for Medicare Supplement Plans?

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Updated July 07, 2024

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What Is Guaranteed Issue for Medicare Supplement Plans?

Guaranteed issue rights for Medicare Supplement insurance (Medigap plans) allow you to purchase a Medigap policy or switch plans without medical underwriting. These Medigap protections apply to specific situations when an insurance company cannot deny you Medigap coverage.

Key Takeaways

Guaranteed issue rights allow you to avoid medical underwriting and purchase a Medigap plan or change plans outside of the open enrollment period.
If you have guaranteed issue rights, insurers must sell you a Medigap plan and cover all your pre-existing conditions without charging a higher rate.
The most common situations for guaranteed issue rights involve changes to your insurance coverage, such as moving outside of your Medicare Advantage plan’s service area.

How Medicare Supplement Guaranteed Issue Rights Work

Outside of the initial Medigap enrollment period, insurers typically use medical underwriting to decide whether to offer you a Medigap policy and at what price. Insurers can deny you a Medigap policy due to your medical history or charge higher rates because of your current or past medical conditions.

If you have a qualifying situation, federal Medigap protections enable you to buy Medigap coverage or change Medigap plans without underwriting. This is called “guaranteed issue rights.”

The Medicare Supplement insurance company must sell you a Medigap policy you qualify for, must cover your pre-existing medical conditions, and can’t charge higher rates due to your medical history.

Having guaranteed issue rights allows you to purchase a Medigap plan outside your Medigap open enrollment period, but there are limitations. Specifically, there are restrictions on which plans you can buy and when you can apply for a plan. You also need to provide proof of the qualifying situation.

The best time to buy a Medigap plan is during your six-month Medigap open enrollment period. This period starts the month you turn 65 and are enrolled in Medicare Part B. During Medigap open enrollment, you can enroll in any Medigap plan offered in your state.

Guaranteed Issue Right Situations

Several scenarios enable you to receive Medigap protections. The most common situations relate to changes to your Medicare Advantage (MA) plan or current Medigap plan. Here are the guaranteed issue right situations that allow you to buy a Medigap plan outside of your Medigap open enrollment period.

In most cases, you can buy any Medigap plan available in your state of residency for which you’re eligible.

Guaranteed Issue Right Scenario	Medigap Plans You Can Purchase	When You Can/Must Enroll
You’re currently enrolled in an MA plan, and you meet one of the following criteria: - Your MA plan leaves Medicare - Your MA plan stops serving your area - You move outside the plan’s coverage area. Now, you want to switch from Medicare Advantage to Original Medicare.	Any Medigap plan	Beginning 60 days before your MA coverage ends; no more than 63 days after your coverage ends
You have Original Medicare and an employer-sponsored health plan that pays after Medicare pays. The employer coverage is ending, including COBRA coverage and retiree coverage. COBRA recipients can purchase Medigap coverage immediately or after COBRA coverage ends.	Any Medigap plan	No more than 63 days after the latest of these dates: - The date your current coverage ends - The date you were notified that your coverage is ending - If you were not notified that your coverage is ending, the date of a denied claim
You have Original Medicare and Medicare SELECT. You relocate outside the Medicare SELECT service area.	Any Medigap Plan	Beginning 60 days before your Medicare SELECT coverage ends; no more than 63 days after your Medicare SELECT coverage ends
You enrolled in a Medicare Advantage plan or a Program of All-Inclusive Care for the Elderly (PACE) during your initial eligibility period. Now, you’ve decided to switch to Original Medicare within the first year.	Any Medigap plan	Beginning 60 days before your MA or PACE coverage ends; no more than 63 days after your MA or PACE coverage ends
In the past, you were enrolled in a Medigap plan. You dropped the plan to enroll in MA for the first time or switch to Medicare SELECT. Within the first year, you want to switch back to Original Medicare and get Medigap coverage.	Only the same Medigap plan you had before you joined the MA plan or got Medicare SELECT if the same insurance company still offers it. If your previous insurance company no longer sells the Medigap plan you had, you can purchase any available plan you qualify for.	Beginning 60 days before your MA or Medicare SELECT coverage ends; no more than 63 days after your MA or Medicare SELECT coverage ends
Your Medigap coverage ends because the insurance company goes bankrupt or you lose coverage for a reason that is not your fault.	Any Medigap plan	No more than 63 days after your current Medigap plan ends
Your insurance company is misleading you or engaging in fraudulent business practices, so you leave your MA or Medigap plans.	Any Medigap plan	No more than 63 days after your Medigap or MA coverage ends
You live in a state that offers an open enrollment period either around your birthday or on an ongoing basis	Depending on the state, you might be allowed to switch Medigap plan letters or switch insurance companies	Follow state rules regarding enrollment.

Guaranteed Issue Right Limitations

Some limitations apply to which Medigap plans you can purchase based on your Medicare eligibility date or state.

If you became eligible for Medicare before January 1, 2020, and have not enrolled in Medigap yet, you can purchase Medigap Plan C or Plan F.

However, if you became eligible for Medicare on or after January 1, 2020, you aren’t eligible for Medigap Plan C or Plan F. In this case, you can purchase Medigap Plan D or Plan G instead of Plan C or Plan F.

States may have a variety of limitations regarding guaranteed issue for Medigap plans. One of the more common is that switching plan letters requires buying a similar plan or one with fewer benefits. For example, you can switch from a more generous Plan G to a more minimalist Plan A. But you can’t switch from a Plan A to a Plan G.

Frequently Asked Questions (FAQs)

How Long Is the Guaranteed Issue Period for Medigap Plans?

For most qualifying situations, the guaranteed issue period for Medigap starts 60 days before your coverage ends and lasts until 63 days after your coverage ends. If you wait to enroll more than 63 days after your coverage ends, you are not guaranteed Medigap coverage, and your application will be subject to medical underwriting.

What Is the Difference Between Open Enrollment and Guaranteed Issues?

Medigap open enrollment is a six-month period when you can enroll in any Medigap plan offered in your state, and acceptance is guaranteed—you won’t pay more or be denied coverage for any health issues or your age. A guaranteed issue right is when a qualifying situation affects your Medigap coverage. When you have a guaranteed issue right, you can purchase a Medigap plan without medical underwriting, similar to the open enrollment period.

Is There a Medicare Supplement Plan That Covers Everything?

No, there isn’t a Medicare Supplement plan that covers every possible cost. Medigap Plan F is the most comprehensive Medicare Supplement plan. It’s unique because it covers the Part B deductible and Part B excess charges.

However, you can only enroll in Plan F if you became eligible for Medicare on or before January 1, 2020. Plan G is the next best option if you don't qualify, as it also covers Part B excess charges. However, Plan G doesn’t cover the Part B deductible.

What is Guaranteed Issue Life Insurance?

Guaranteed issue life insurance is a type of whole life insurance that isn’t medically underwritten. So, there’s no required medical exam or health questionnaire. Insurance companies cannot deny coverage because of your current or past medical history. Guaranteed issue life insurance usually charges a higher premium for a lower coverage amount than a medically underwritten term policy.

Guaranteed issue life insurance has nothing to do with guaranteed issue for Medicare Supplement plans.

The Bottom Line

Guaranteed issue rights for Medigap allow you to purchase a Medicare Supplement plan outside of your initial Medigap open enrollment period without medical underwriting. Typically, guaranteed issue rights occur when your health insurance coverage changes or you lose coverage.

If you have a guaranteed issue right, you must buy the new Medigap plan no more than 63 days after your coverage ends. Additionally, there may be some limitations on Medigap plans you can enroll in.

Article Sources

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Medicare.gov. “Get Ready to Buy: Your Medigap Open Enrollment Period.”
Medicare.gov. “What Are Guaranteed Issue Rights?”
Medicare.gov. “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare.” Page 10.