There's a Window Where a Medigap Insurer Can't Say No. Most People Miss It.
Updated: 4 days ago
For a few weeks of your life, a Medicare Supplement insurer is not allowed to ask about your health. Most people find out about that window after it has closed.
What guaranteed issue actually means
Guaranteed issue is a federal right. When you have it, an insurer selling Medicare Supplement coverage cannot ask you health questions, cannot charge you more because of your health, and cannot turn you down. It applies to a set list of standardized plan letters, not to every plan on the market, and it lasts a fixed number of days.
What waiting can cost
Outside that right, a Medigap application is medically underwritten. The insurer can review your health history, price accordingly, and decline you. There is no appeal to a declination and no second window. A diagnosis between the day the door opens and the day you apply can change the answer.
When the door opens
The widest window comes first, and it does not come back. It is the six months that start the first day of the month you are 65 or older and enrolled in Part B. In that window you can buy any Medigap policy sold in your state, no health questions asked.
After that, the right opens only when something specific happens to your coverage:
Your Medicare Advantage plan leaves Medicare, stops serving your area, or you move out of its service area.
You lose Medigap coverage through no fault of your own, such as the company going bankrupt or breaking the rules.
You joined a Medicare Advantage plan when you first became eligible at 65 and want to return to Original Medicare within your first year.
You dropped a Medigap policy to try Medicare Advantage for the first time and want to switch back within 12 months.
When a plan is ending, you can apply as early as 60 days before your coverage ends and no more than 63 days after it ends. The 63 days is the part people run out of.
Takeaway
Guaranteed issue is one of the few places in Medicare where the answer is decided before you ask. The catch is that it does not stay open, and nothing arrives in the mail to tell you the window closed.
Not sure which window you are in, or whether you have one at all? Send us the dates and we can educate you on it.
Sources
Medicare.gov, When can I buy a Medigap policy? — guaranteed issue situations, the 60 and 63 day timing, and the six-month Medigap open enrollment period: https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy/when
Disclaimer: This information is for educational purposes only. Benefits, costs, and coverage vary by plan and area. Medicare rules may change.
Content for educational purposes only. AskGen is not affiliated with or endorsed by the U.S. government or the federal Medicare program.
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