While many people are currently assessing their health insurance options for fall’s Open Enrollment, running from October 15 through December 7, some may have questions about their options regarding Medicare, Medigap policies, and Guaranteed Issue Rights. If you are enrolled in or interested in enrolling in a Medigap policy, these policies are not subject to Medicare’s Open Enrollment period.

A Medigap policy, or Medicare Supplement Insurance policy, helps to fill the “gaps” by serving as a supplement to Original Medicare, covering a portion of remaining health costs, such as copayments, coinsurance, and deductibles. These types of policies are sold by private health insurance companies and charge a monthly premium for coverage, in addition to the Part B premium you pay to Medicare.

Most people enroll in these policies during their Medicare Initial Enrollment Period when companies must sell you a policy. However, if you choose to purchase a Medigap policy at a later date, you have the right to purchase a policy at any time, but options can still be limited. Outside of the Initial Enrollment Period, the company will underwrite the policy, meaning they can charge higher rates based on health conditions or refuse to sell you a policy altogether.

However, there are time periods during which the health insurance company:

  • Must sell you a Medigap policy,
  • Must cover all pre-existing health conditions; and
  • Cannot charge a higher monthly premium because of past or present health conditions.

The above protections, known as Guaranteed Issue Rights, are triggered by certain situations or life changes:

  • Your Medicare Advantage Plan stops providing services in your area, or you move out of the plan’s service area
  • You lose coverage through an employer group health plan or union (including retiree or COBRA coverage)
  • You move out of your Medicare SELECT policy’s service area
  • You joined a Medicare Advantage Plan during your Initial Enrollment Period, and within a year of joining you decide to switch to Original Medicare
  • You dropped a Medigap policy to join a Medicare Advantage Plan for the first time, and within a year of joining you decide to switch back
  • Your Medigap insurance company goes bankrupt and/or otherwise ends your coverage through no fault of your own
  • You leave a Medicare Advantage Plan or Medigap policy because they did not follow the rules, or misled you

Please keep in mind the time period to take advantage of the protections mentioned above is usually limited to 63 days, beginning the date previous coverage has ended. Since Medicare does not inform its recipients they have experienced a triggering event, it is important to keep track of these protections to ensure you and your loved ones are receiving the best health care possible.