If you are new to Medicare or wanting to change plans from Medicare Advantage to Medigap, you need to know about the difference between Open Enrollment and Guaranteed Issue. If you have any health conditions, the insurance company can turn you down if you are applying for a Medigap or Medicare Supplement Plan.
They don’t have to accept you because of your health condition.
It’s not like a Medicare Advantage Plan where they must accept you. They don’t have to accept you into their Medigap plan.
That is, unless you qualify under the Open Enrollment or Guaranteed Issue rules.
Open Enrollment is something that everyone gets when they first turn 65 (or later) and obtain their Part B. This period of time is when the insurance company cannot refuse to cover you, no matter what your medical conditions are.
This is good for you, the consumer, because having original Medicare with a Medigap plan gives you freedom of choice.
You’ll have the freedom to select any doctor who accepts Medicare, and you don’t have a limited “network” like the Medicare Advantage plans have.
You can even go out of state with a Medigap plan.
But what if you missed your open enrollment period?
You might have selected an MAPD plan and have been on it for many years.
Perhaps you want to see a mobile doctor who is not in your network.
If you have health conditions your insurance company doesn’t have to sell you there Medigap policy.
Unless you have a guaranteed issue.
Guaranteed issue is similar to open enrollment, but happens during certain occasions. This can be you losing employer coverage. It can be when your MAPD plan leaves your area, or when you move out of the coverage area.
There are a number of times when you’ll have a GI right to get a Medigap plan.
Why haven’t you heard of this before?
Chances are, it’s because the insurance agent or broker doesn’t get paid to assist you with a GI. Or the insurance broker might get paid very little to assist you. It could take many hours to go through the paperwork, plus the insurance agent has to take on liability for assisting you. Most insurance agents are very helpful, but they can’t afford to take on a client and not get paid for it.
Watch this video to obtain more information about the differences between Open Enrollment and Guaranteed Issue as it relates to Medigap plans.
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