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Your Right to Buy Medigap Supplemental Health Insurance

Guaranteed issue rights (also called "Medigap protections") protect your right as a senior consumer to purchase a Medigap health insurance policy. They are rights you have in certain situations that make it necessary for insurance companies to sell you a Medigap policy, even if you have a pre-existing health condition.

In these cases, insurance companies are required by law to sell you a Medigap policy, despite any pre-existing conditions, and they must not charge you more because of those conditions.

Residents of Massachusetts, Wisconson, and Wyoming are covered by guaranteed issue rights, but the related Medigap insurance policies vary.

Guaranteed issue rights apply when your other senior health care coverage (such as Medicare) changes, for example, if you've lost or dropped your coverage. It's important that you keep any notices, letters, and claim denials from your original health insurance company, as well as the postmarked envelopes in which they were mailed. When you apply for your new Medigap policy, they act as evidence that you have a guaranteed issue right.

To prevent breaks in coverage, you should apply for your Medigap supplemental health insurance policy for seniors before your prior coverage has ended. You can arrange to have your Medigap policy begin the day after your other health insurance policy is terminated.

Medigap Guaranteed Issue Rights Situations

There are a number of situations under which a supplemental health insurance company cannot refuse to sell you a policy. These situations include:

  1. If you are in a Medicare Advantage Plan, and the plan separates from the Medicare Program or no longer provides service in your area; or if you move away from the service area.
  2. Your Original Medicare Plan, which is provided by a union or employer group health insurance plan, is ending.
  3. You have a Medicare SELECT policy along with the Original Medicare Plan, and you move out of the Medicare SELECT coverage area.
  4. Trial Right* - You joined a Medicare Advantage or PACE plan when you first signed up for Medicare at age 65, and within the first year, you want to switch to the Original Medicare Plan.
  5. Trial Right* - You stopped your Medigap coverage to join a Medicare Advantage or Medicare SELECT plan for the first time, and within your first year, you want to change back.

* A trial right gives you the ability to try out the Medicare Advantage Program, but to switch to a Medigap policy if you change your mind.

State laws vary for all guaranteed issue rights situations and their solutions. Please check the Medigap information page for your state for more details.

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