What are the rules if you initially enroll in a Medicare Advantage Plan and then want to switch to a Medigap plan?
Guarantee issue rights – sometimes called “Medigap protections” are rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy even if you have health problems called “pre-existing conditions”.
In these situations, an insurance company:
- Must sell you a Medigap policy,
- Must cover all your pre-existing conditions and
- Can’t charge you more for a Medigap policy because of past or present health problems.
In many cases, you have a guaranteed issue right when you have other health coverage that changes in some way, such as when you lose or drop the other health care coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan and still buy a Medigap policy if you change your mind.
An insurance company can’t refuse to sell you a Medigap policy under the following situations:
Situation 1: Trial Period and 24 Month Rule – Enrolling into a Medicare Advantage Plan for the very first time. The rule states the individual must enroll in a Medicare Advantage Plan for the first time when the following takes place – the member’s Part A effective date must be the same month they turn 65 – the Medicare Advantage Plan must be effective the month they turn 65 – it must also be their 1st time in an Medicare Advantage Plan – so, if an individual turns 65 in November of 2017 – their Part A must be effective November of 2017 – their Medicare Advantage Plan must be effective in November of 2017 and it must be the member’s 1st Medicare Advantage Plan – if that is the case, they are in their Trial Period – from November of 2017 through October of 2018, they can dis-enroll from their Medicare Advantage Plan at any time and get a Medicare Supplemental Policy and a Part D Prescription Drug Plan (if they require prescription drug coverage) and they will both be guarantee issue. If they choose not to dis-enroll their first year, the guarantee issue window will extend an additional 12 months – however, in the second 12 month window, the member cannot dis-enroll anytime, they can only dis-enroll if there is a window of opportunity which includes – any approved Special Election Period – the Medicare Advantage Open Enrollment Period (January 1st – March 31st) and the Medicare Annual Election Period (October 15th – December 7th) .
Situation 2: Trial Period and 24 Month rule – If one is going from a Medicare Supplemental Policy to a Medicare Advantage Plan for the first time, which usually takes place during AEP. If a member changes from a Medicare Supplement to a Medicare Advantage Plan for the 1st time January 1st, 2018 – they are in their Trial Period – from January 2018 through December of 2018. During that period they can dis-enroll from their Medicare Advantage Plan and enroll in a Medicare Supplemental Policy and Part D Prescription Drug Plan (if they require prescription drug coverage) and they will be guarantee issue – if they choose not to dis-enroll their first year, the guarantee issue window will extend an additional 12 months – however, in the second 12 month window, the member cannot dis-enroll anytime, they can only dis-enroll if there is a window of opportunity which includes – any approved Special Election Period – the Medicare Advantage Open Enrollment Period (January 1st – March 31st) and the Medicare Annual Election Period (October 15th – December 7th) . ***Plan choices in your state may be limited.
I don’t have a guaranteed reason, what kind of underwriting is there?
We can help you review the health questions on the paper applications for the companies we represent.
See Medicare.gov rights and protections
For plan choices and pricing in your area, please inquire (858) 391-8544
