Medicare Supplement – Guaranteed Issue & Open Enrollment

The Medicare Supplement industry have certain rules and regulations pertaining to “guarantee-issue” situations and “open-enrollment.”  Below are the rules that apply.

Medicare Supplement Guaranteed Issue Guidelines

  • The Initial Enrollment Period: You have a 7 month window of opportunity, starting 3 months prior to your Medicare Part B coverage month start date, the month of the start date and ending 3 months after the month of your birthday or Part B start date.  During this time you can choose any Medicare Supplement plan or company providing coverage in your resident state.
  • Special Enrollment for Part B: Part B enrollment may be delayed if you are over age 65 and  have group health insurance as a result of your current employment or your spouse’s current employee health plan.  Or, you are disabled and continue your employers group health insurance plan.  In any of these instances, you will qualify for a special 63 day enrollment period beginning the month after the termination of your group health insurance.  If you do not enroll by the end of this grace period, you will have to answer the health questions on the application and be approved medically.
  • If you loose your Medicare Advantage plan coverage due to one of these reasons:  A) Medicare Health Plan terminates or stops providing care in your area.  B) Beneficiary moves outside the Medicare Health Plan service area.  C) Beneficiary leaves the plan because it failed to meet it’s required obligations to them.  D) The beneficiary must enroll in a Medicare Supplement plan within 63 days of losing coverage.
  • (Trial Right) You enrolled in a Medicare Advantage plan for the first time, either when you first became eligible for Medicare Part B or after having a Medicare Supplement plan.  Then within the first year of joining the Medicare Advantage plan, you wish to cancel or dis-enroll and switch to Original Medicare and a Medicare Supplement plan company and plan of your choice.
  • Birthday Rule (California Only) You are entitled to switch companies to a plan with equal or less benefits for 30 days beginning on your birthday.  You must currently have a Medicare Supplement plan, and provide proof of prior coverage.
  • Military – Termination of health care for military retiree or spouse or dependents due to military base closure, base no longer offers services, or you relocated.  If you are a Medicare eligible military retiree or dependent and at least 65 you are entitled to a 6-month guaranteed issue period beginning the date you lost health care services at the military base.  You must provide proof of prior coverage.
  • Your Medicare Advantage plan, reduces benefits, increases the cost sharing amount, or discontinues a provider for other than good cause.  If any of these events occur you are entitled to a guaranteed issue period of 63 days.  You must provide proof of prior coverage.
  • Disabled and receiving Medicare benefits prior to your 65th birthday.  Once your Medicare Part B coverage is approved you will be offered a 6-month guaranteed issue period.  You will then be offered an additional 6 month period beginning with the date of your 65th birthday.

Quick Links …

There may be other guaranteed enrollment opportunities in your state, so please call so we can discuss your current situation.

Call Today … 800-700-1246

John Conner

7 thoughts on “Medicare Supplement – Guaranteed Issue & Open Enrollment

  1. Amy sawyer

    John, thank you for the time you spent with me trying to find out a solution to my insurance issues. God bless

  2. Pingback: Anthem Blue Cross Medicare Supplement Indiana | ConnerHealth.com

  3. john Post author

    Gordon, that is correct, although is certain states, a person under age 65 on Medicare with ESRD (End Stage Renal Disease) will not qualify, even if within the 6 month window.

    Thank .. John

  4. gordon

    John,
    Thanks for the site, but you have a problem with the open
    enrollment time period for medigap policy.
    From medicare.gov:
    You have a 6-month Medigap Open
    Enrollment Period which starts the first month you’re 65 and enrolled
    in Part B. This period gives you a guaranteed right to buy any Medigap
    policy sold in your state regardless of your health status.

    http://www.medicare.gov/publications/pubs/pdf/10050.pdf

  5. Richard A. Picka

    Hello, Mr. Conner. I am 57 years old and disabled. I had insurance with my wife’s employer and used my Medicare for my secondary insurance. She now lost her job, so I am seeking a Medigap policy. The coverage ends 04/30/2011 I am interested in policy F, monthly premiums, with automatic withdrawals from my checking account. My medications are: Sotalol 80mg, Allopurinol 300mg, Byetta 10mcg, Hydroxyzine HCL 25mg, Hydrocodone/Acetaminophen 10/650, Doxepin 150mg, Pradaxa 150mg, Aspirin 325mg, Lexapro 10mg, Metaformin HCL 1000mg, and Tamsulosin HCL 0.4mg. I am 5′ 9 1/4″ and weigh 197 lbs. and live in Murray, KY 42071. In the past 2 years, I have been hospitalized for a small bowel obstruction, which resolved itself, a extremely bad headache, which was sinus related, and gout. From what I can tell, you have access to a number of insurance companies, so if anyone can help me find an underwriter for the plan F medigap policy, it would be you. I thank you, in advance for your time and trouble…Richard A. Picka

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