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When is Medigap guaranteed issue?

When do you have a guaranteed right to buy a Medigap policy?  That is, when is an insurance company required to sell you a Medigap policy if you want to purchase one?  You have the right to purchase a Medigap policy during the open enrollment period when you turn 65, but there are also other situations in which an insurance company must sell you a policy, cover all pre-existing conditions and cannot charge you a higher price for past or present health problems.  They are:

  • When you purchase a Medicare Advantage plan for the first time and decide within the first 12 months that you don’t like it and switch back to Original Medicare.  You have 63 days from the date your coverage ends to purchase the Medigap policy.
  • When you are in a Medicare Advantage plan, and your plan is leaving Medicare.  If you switch back to Original Medicare, you then have up to 63 days after your health care coverage ends to purchase a guaranteed-issue Medigap plan.
  • When you have an employer group health plan that pays after Medicare and that plan ends. You have 63 days after the latter of these three events: date the coverage ends, date on the letter notifying you that coverage is ending, or date on a claim denial when you first find out that your coverage is ending.
  • When you are in a Medicare SELECT policy and you move out of the plan’s service area.  You can stay with the same company’s regular Medigap plan, or you can switch to another Medigap plan within 63 days of the SELECT plan coverage ending.
  • When you drop a Medigap policy to switch to a SELECT policy or to join a Medicare Advantage plan for the first time.  If you have been in the plan less than a year, you can switch back to your old Medigap policy or purchase Plan A, B, C, F, K, or L if your old Medigap plan is no longer available.  You cannot, however, get back the drug coverage that your old plan may have had.  You have 63 days to buy the Medigap plan after your coverage ends.
  • If your Medigap insurance company fails or your policy coverage ends through no fault of yours. 
  • If you leave a Medicare Advantage plan or drop a Medigap policy because the insurer has misled you.