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Medicare Guarantee Issue and Free Look Periods

 

Many people with original Medicare also buy a Medigap policy, along with a Part D prescription drug plan. (Another option is to enroll in Medicare Advantage, also known as Medicare Part C, which offers comprehensive coverage if you stay in-network.)

With Parts C (Medicare Advantage Plans) and Part D - you can generally move back and forth between plans without penalty during open enrollment; which occurs every year from October 15th to December 7th. Changing your Medigap coverage can be difficult and expensive, so it’s essential to buy it right the first time.

Medigap plans are not subject to the Annual Open Enrollment period as are Medicare Advantage Plans and Medicare (Part D) Prescription Drug Plans. With Medicare Advantage Plan and Drug Plans, you won’t be charged higher rates or denied coverage because of your age or pre-existing health conditions.

Not so with Medigap. The insurers who sell these plans may raise your rates if you switch - or even refuse to sell you a policy at all if you miss the enrollment window or have a significant pre-existing condition.

The key issue here is whether you are entitled at the time you buy a Medigap policy to what is called “guaranteed issue rights.” If you have these rights, an insurance company must sell you a Medigap policy and cover all your pre-existing health conditions.

Guaranteed issue rights are available after you first become eligible for Medicare and sign up for Part B coverage. If you buy a Medigap policy during this six-month window, you will get these rights for whatever Medigap policy you choose.

There are two limited opportunities when guaranteed issue rights exist:

  1. If you’re on original Medicare with Medigap, and opt to buy a Medicare Advantage plan during open enrollment, you will have to drop your Medigap policy. But you can change your mind within a year and retain a guaranteed issue right to your old Medigap plan.
  2. If you joined a Medicare Advantage plan when you were first eligible for Medicare, you can change your mind within a year and switch to original Medicare. If you want to buy a Medigap policy at that time, you will have guaranteed issue rights.

Guaranteed issue rights do not guarantee you will pay the same premium price for Medigap the rest of your life. So before you enroll, check out the insurer’s underwriting rules and consult with an experienced independent broker / agent.

If you want to switch Medigap policies, don’t cancel your old coverage right away. You will have a 30-day “free look period” to decide whether to keep the new policy.

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