Common Guaranteed Issue Reasons for Medicare Supplements

So much of pre-65 health care involves medical underwriting (for now, anyway).  One welcomed benefit to Medicare Medigap is that for most people, it will be guaranteed issue regardless of health as long as you meet certain requirements.  Let's go over the most common of these to make sure we do not lose these windows of eligibility.  We'll start with the most common situations and work our way down.

The #1 reason for guaranteed issue eligibility is to be age 65 or older and have newly enrolled in Part B with an effective date no more than 6 months prior.  This accounts for the bulk of enrollees.  So there are two parts.  Enroll in Part B and then either prior to the Part B effective date but no later than 6 months following, apply for your Medicare supplement plan. 

The #2 reason is for people under the age of 65 who become permanently disabled as designed by Social Security and are enrolled in Part B with the same time requirement above.  Once you get your Part B as a result of being permanently disabled, immediately coordinate your Medicare supplement plan. 

Reason #3 is for a person age 65 or older who leaves a group health insurance plans.  These people will have a 6 month guaranteed issue window from last date of group health insurance.  Keep in mind that Part B must still be enrolled to be eligible for a Medicare supplement plan.

Reason #4.  If you have a Medicare Advantage plan and the carrier either closes the plan or leaves your area or if you move to an area where that MA plan is no longer available, you will have 123 days from the last date of MA coverage to qualify for any Medicare supplement plan in your area on a guaranteed issue basis.

Reason #5.  If you are age 65 or older and receive health care from a Military base or facility that closes, stops offering health care, or if you relocate to an area where military benefits are not offered, you have a six month window for said individuals and dependents over age 65. 

Reason #6.  Upon becoming eligible for Medicare, you enrolled in a Medicare Advantage plan and then dis-enrolled within 12 months, you have a 63 day window or the 1 year anniversary of your MA enrollment (whichever is less) to qualify for a Medigap plan guaranteed issue.

Reason #7.  If you leave a Medigap plan for a MA, Pace, or Select plan, you can switch back to your original Medicare supplement when dis-enrolling with 12 months from MA, Pace, or Select plan.  You will have up till 63 day or date of anniversary window, which ever is lesser to make change guaranteed issue.

Reason #8.  You are entitled to change to a Medicare supplement plan of equal or lesser benefit within 30 days from your birthdate if you already have a Medigap plan.

Reason #9.  If your plan terminated due to fraud by the carrier, you will have a 30 day window from date of termination or date of fraud determination (which ever is later) to qualify for a Medigap plan.

Reason #10.  You will have a 63 day window if your MA plan reduces benefits, increases cost sharing, or discontinues provider for other than good cause.

These are main reasons for Medigap guaranteed issue.  It's best to contact us as a license Medicare supplement agent to make sure you do not lose or lapse any available windows for you.  Keep in mind that Part A and B are always prerequisites to purchasing a Medigap plan.