DEFINITION of Guaranteed Issue Rights
Guaranteed issue rights are rights afforded to individuals insured under Medicare that requires insurance companies to offer Medicare supplement insurance, also called a Medigap policy. Guaranteed issue rights prevent insurers from denying a Medigap policy, from placing restrictions on the policy due to previous medical conditions, or from charging more because of previous conditions.
BREAKING DOWN Guaranteed Issue Rights
Guaranteed issue rights, also called Medigap protections, protect individuals who lose their health care coverage or if their health care coverage changes. These rights apply to those who have a form of Medicare insurance already, including Original Medicare and Medicare Advantage, or if the individual previously had Medigap insurance but later moved to a different form of Medicare. In order to qualify an individual must have both Medicare Part A and Medicare Part B, but the individual is not allowed to purchase the policy if he or she already has a Medicare Medical Savings Account.
Guaranteed issue rights are provided by the United States federal government. States may provide individuals with additional rights. All Medigap policies must comply with state and federal regulations, and are identified as Medicare supplement insurance. Policies offer a standard profile of benefits, though additional benefits may be purchased based on individual needs. Medigap policies are sold by insurance companies, which are allowed to determine the type of policies that they offer. As long as the policyholder pays the premium an insurance company is not allowed to cancel the policy. The policy only applies to individuals and not families.
Individuals who lose their health coverage and are eligible for Medigap insurance must provide proof of their insurance coverage being denied. Types of proof include letters, emails, and other notices that have personal identifiable information on them. It is important that these notifications include a timestamp.
Situations Applicable to Guaranteed Issue Rights
Guaranteed issue rights apply when...
- You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.
- You have 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.
- You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy's service area.
- You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.
- You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back.
- Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
- You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you.