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Can I buy a Medigap policy if I lose my health care coverage?

Because you may have a guaranteed issue right to buy a Medigap policy, make sure you keep these:

  1. A copy of any letters, notices, emails, and/or claim denials that have your name on them as proof of your coverage being terminated
  2. The postmarked envelope these papers come in as proof of when it was mailed

You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right.

If you have a Medicare Advantage Plan  but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the plan. Ask that the new policy take effect no later than when your Medicare Advantage enrollment ends, so you’ll have continuous coverage.

For more information please see " 2014 Choosing a Medigap Policy" produced and made available by CMS.

                                                   (Link requires Adobe Acrobat to open)

Some of the situations listed include loss of coverage under Programs of All-inclusive Care for the Elderly (PACE). PACE combines medical, social, and long-term care services, and prescription drug coverage for frail people. To be eligible for PACE, you must meet certain conditions. PACE may be available in states that have chosen it as an optional Medicaid  benefit.

If you have Medicaid, an insurance company can sell you a Medigap policyonly in certain situations.

For more information about PACE, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227).

TTY users should call 1-877-486-2048.

This chart describes the situations that give you a right to buy a policy,

the kind of policy you can buy,

and when you can or must apply for it. (continued)

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What is Guaranteed Issue?

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Below is the official Guidelines per CMS

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What are guaranteed issue rights?

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*As explained on pages 14–16, the best time to buy a Medigap policy is during your Medigap Open Enrollment Period,

when you have the right to buy any Medigap policy offered in your state. However, even if you are not in your Medigap Open Enrollment Period,

there are several situations in which you may still have a guaranteed right to buy a Medigap policy.

*See pages 22–23 for more information.

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Guaranteed issue rights are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company must:

  1. Sell you a Medigap policy
  2. Cover all your pre-existing health conditions
  3. Can’t charge you more for a Medigap policy regardless of past or present health problems

If you live in Massachusetts, Minnesota, or Wisconsin, you have guaranteed issue rights to buy a Medigap policy, but the Medigap policies are different.

*See pages 42– 44 for your Medigap policy choices.

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*Pages referenced are from the"2014 Choosing a Medigap Policy" book produced and made available by CMS.

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When do I have guaranteed issue rights?

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In most cases, you have a guaranteed issue right when you have certain types of other health care coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a "trial right" to try a Medicare Advantage Plan  and still buy a Medigap policy if you change your mind.

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This chart describes the situations that give you a right to buy a policy, the kind of policy you can buy,

and when you can or must apply for it.