Guaranteed Issue Medicare Supplement

When is the best time to apply for a Medigap plan?

Guaranteed issue Medicare supplement rights allow you to apply for a Medigap plan at specific times and, in certain instances, without the need to undergo medical underwriting.

The CMS is a Federal agency responsible for regulating the Medicare and Medigap industry. Private insurers sell Medigap plans, but they must ensure every plan they offer in the Medigap range has the same standardized benefits enforced by the CMS.

So, the Medigap industry and benefits offered by Medigap providers are consistent across plans and insurers. That means you get the same standardized benefits if you take a Plan G policy from Physicians Mutual or Aetna. All Medigap plans offer the following benefits.

• Part A coinsurance and hospital costs for up to 365 days after using up Medicare benefits.
• Part A hospice care coinsurance or copayment.
• Part B coinsurance or copayment.
• Blood transfusion costs for the first three pints of blood.

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Plans F*, G, and N offer additional Medicare Parts A & B benefits.

• Part A deductible.
• Part B excess charges (Plan N doesn’t cover these charges).
• Skilled nursing facility care coinsurance.
• 80% of emergency healthcare costs when traveling outside the US for 60 days. ($250 deductible and $50,000 maximum apply).
• Unlimited coverage for all out-of-pocket costs.

*Plan F is the only Medigap policy covering the $226 Part B deductible. However, due to measures introduced in 2020, new Medicare beneficiaries eligible after January 1, 2020, cannot apply for Plan F. Instead, they must go for Plan G for near-comprehensive insurance. The only difference between Plans G & F is that Plan G doesn’t cover the Part B deductible; all other benefits remain the same.

Medigap plans don’t cover preventative treatments like maintenance visits to the chiropractor or physiotherapist. They also don’t cover the costs of private-duty nursing or stays in nursing homes. The benefits offered in Medigap plans are only for Part A & B expenses. Therefore, there’s no coverage for prescriptions or hearing, dental, or vision services.

Medigap “guaranteed issue rights” protect applicants from undergoing medical underwriting when signing up for a Medigap policy with insurers. These rights are applicable during the “Open Enrollment” period starting from the day of the beneficiaries 65th birthday and lasting six months from that date.

During this time, the applicant may purchase any Medigap policy they want from any provider. The insurer may not use medical underwriting to prevent the beneficiary from joining their Medigap scheme or to charge higher-than-average premiums for the plan.

Medical underwriting is a process whereby the insurer asks the applicant questions surrounding their health status and medical history. Suppose the insurer feels the applicant is “high risk” to insure. In that case, they may decide to charge higher-than-average premiums to compensate for the risk of insuring the applicant or refuse the application.

Guaranteed issue rights allow you to enroll in a Medigap plan with a provider without undergoing medical underwriting.

If you’re moving states to an area where your current provider doesn’t operate or doesn’t offer your plan, qualify for a guaranteed issue right to find another provider. Suppose you have a Medicare Advantage policy and move outside the coverage area.

In that case, you have a guaranteed issue right to find a new provider or switch from Medicare Advantage to Original Medicare and Medigap. You can make the change no later than 63 days after your Medicare Advantage coverage ends.

If you have questions about Medicare Supplement plans, call our team at 1-888-891-0229. We offer professional advice on Medigap policies. Our fully licensed agents offer free consultations to give you all the information you need about Medigap. If you want someone to call you back, leave your details on our contact form, and we’ll get a Medigap expert to reach out to you.