- Guaranteed issue rights, also known as “Medigap protections,” refer to the rights that Medicare beneficiaries have to purchase a Medicare Supplement Insurance (Medigap) policy without being denied coverage or charged more due to a pre-existing medical condition.
- If a Medicare beneficiary is interested in purchasing a Medigap policy, in certain situations, they have guaranteed issue rights that allow the purchase of a policy without being denied coverage or charged more due to medical history. These rights apply to certain situations, such as when a beneficiary first becomes eligible for Medicare, when coverage is lost through an employer or group health plan, or when a beneficiary moves out of the service area of their current Medigap policy.
- It is important to note that guaranteed issue rights do not apply in all situations, and a beneficiary may not be eligible for these rights if they have had a Medigap policy in the past and let it expire or if they are eligible for a Medicare Advantage plan. In these cases, the beneficiary may be required to undergo medical underwriting, which means that the Medigap insurer can consider their medical history when deciding whether to offer coverage and at what price.
- If a beneficiary has any questions about their guaranteed issue rights or about purchasing a Medigap policy, it is recommended that they contact a Medigap insurer or speak with a Medicare representative. The beneficiary may also want to discuss their coverage options with their healthcare provider to ensure that they understand the treatment options and any potential out-of-pocket costs.
