“Guaranteed issue rights” refers to situations in which Medigap insurers cannot deny you coverage based on age, gender, health status, or any preexisting conditions outside of the open enrollment period.
Medigap is an additional insurance option that can help you cover your out-of-pocket Medicare costs. Private companies offer Medigap plans, which are also known as Medicare supplement plans. Medigap can help cover expenses such as deductibles, copayments, and coinsurance.
Read on to learn about guaranteed issue rights and when insurers cannot deny you a Medigap policy.
Under federal law, you have a 6-month Medigap open enrollment period when you turn 65 years old and enroll in Medicare Part B.
You can enroll in any Medigap policy without medical underwriting during this time. This means an insurer cannot deny you coverage based on preexisting conditions, so you can select the best plan for you. Once the open enrollment period ends, you may have to pay more to enroll or may be denied coverage.
That said, there are situations in which Medigap insurers cannot deny coverage even outside of the open enrollment period.
In those specific cases, your preferred insurer must sell you a Medigap plan, and they cannot charge you more based on your past or current health. These are called guaranteed issue rights.
This table outlines the main scenarios in which you’re eligible to purchase a Medigap policy outside of your Medigap open enrollment period and cannot be denied.
| Scenario | You have the right to buy | Time frame |
|---|---|---|
| Your Medicare Advantage Plan is changing or no longer available in your area, or you’re moving out of the service area. | plan A, B, C, D, F, G, K, or L if you switch to Original Medicare instead of joining a different Medicare Advantage Plan | 60 days before and no more than 63 days after your Medicare Advantage Plan coverage ends |
| You have Original Medicare and an employer or union plan that pays after Medicare (including COBRA), and that plan is ending. | plan A, B, C, D, F, G, K, or L (Note: If you have COBRA coverage, you can buy a Medigap policy now or after your COBRA coverage ends.) | Within 63 days of the latest of these dates: • the end date of your current coverage • your receipt of notice that your coverage will end • your receipt of notice of a claim denial |
| You have Original Medicare and a Medicare SELECT policy but then relocate outside the policy’s service area. | plan A, B, C, D, F, G, K, or L, sold in your current state or the state you’re moving to | 60 days before or after your Medicare SELECT coverage ends |
| You initially joined a Medicare Advantage Plan or PACE when first eligible for Medicare and want to switch to Original Medicare within the first year. | any Medigap policy sold in your state | 60 days before or after your coverage ends |
| You switched to a Medicare Advantage Plan (or Medicare SELECT) within the past year and want to switch again. | plan A, B, C, D, F, G, K, or L from another insurance company in your state (Note: If you had a Medigap policy before joining Medicare Advantage or Medicare SELECT, you may be able to keep it.) | 60 days before and up to 63 days after your coverage ends |
| Your Medigap insurer goes bankrupt or your policy is terminated through no fault of your own. | plan A, B, C, D, F, G, K, or L from another insurance company in your state (Note: If you had a Medigap policy before joining Medicare Advantage or Medicare SELECT, you may be able to keep it.) | up to 63 days after your current Medigap coverage ends |
| You switch or cancel your Medicare Advantage plan or Medigap policy due to a violation or misleading information by the company. | plan A, B, C, D, F, G, K, or L from another insurance company in your state | up to 63 days after your current Medigap coverage ends |
As of January 1, 2020, new Medicare recipients are no longer offered Plan C or Plan F. But if you qualified for Medicare before that date, you may still be able to buy these plans. If you qualify after that date, you can choose Plan D or Plan G instead.
Your state may have some specific limitations that do not apply nationwide. On the other hand, you may have a longer guaranteed period in some states. For this reason, it’s important to research your local laws.
Can Medigap deny preexisting conditions?
Insurers cannot deny you a Medigap plan based on preexisting conditions during the open enrollment period or if you qualify based on guaranteed issue rights.
What states have additional guaranteed issue protections for Medigap?
As of 2024, Connecticut, Massachusetts, Maine, and New York require guaranteed issue rights protections either continuously or year-round. Note that this may change yearly, so it’s a good idea to verify the 2025 policy in your state.
What is a major problem with guaranteed issue in Medigap?
One problem might be the limited time frame and scenarios in which you have guaranteed issue rights for Medigap. These limitations mean that many people are excluded from guaranteed issue protections.
Medigap plans, also known as Medicare supplement plans, can help you pay for out-of-pocket costs from Original Medicare.
“Guaranteed issue rights” refer to the circumstances in which Medigap insurers cannot deny you coverage outside of the enrollment period based on factors such as age, gender, health status, or any preexisting conditions.