Last updated December 5, 2023
When to use:
Caller has questions about guaranteed issue rights.
Guaranteed Issue Rights:
Guaranteed issue rights are rights a person has when insurance companies are required by law to sell them specific Medigap policies outside of their initial open enrollment period, even if they have a pre-existing health condition.
Policies that can be purchased with Guaranteed Issue Rights:
A person with guaranteed issue rights can purchase a Basic Medigap policy.
People new to Medicare after January 1, 2020, can add two optional riders: Medicare Part A deductible and Medicare Part B excess charges.
People who were eligible for Medicare before January 1, 2020, can also add the Medicare Part B annual deductible rider.
Guaranteed issue rights do not apply to the Medicare basic preventive rider of other Medigap policies.
When companies are required to sell a Medigap policy:
A person('s):
- Health plan or Medigap policy is no longer offered
- Has Original Medicare and an employer group health plan (including retiree coverage) that pays after Medicare pays and that plan is ending
- Moves away from their Medicare health plan or Medicare SELECT plan service area
- Loses coverage because the insurance company goes bankrupt
- Leaves a Medicare Advantage or Medicare Cost Plan or drops a Medigap policy, because the company had not followed the rules or has misled them
Trial right eligibility criteria:
A person is eligible for a trial right period if:
- They join a Medicare advantage Plan when they are first eligible for Medicare Part A at age 65
- During the first 12 months, they can switch to Original Medicare and purchase a Medigap policy
- They drop a Medigap policy to join a Medicare health plan (Advantage or Cost Plan) or Medicare SELECT plan for the first time
- During the first 12 months after enrolling in the new plan, they can return to Original Medicare and the Medigap policy they dropped
Length of Special Enrollment Period:
If a person's plan is ending and they have guaranteed issue rights, they will have a special enrollment period.
In most cases, they have up to 63 days from their coverage end date to purchase a new Medigap policy. If possible, they should apply before their current coverage ends.
Showing proof of eligibility:
A person must show they have guaranteed issue rights to the insurance company prior to the purchase of a new policy.
They should keep the following items as proof:
- Letters, notices, and claim denials that show coverage was terminated
- Postmarked envelopes, which show dates mailed
- Anything from the insurance company with their name on it
GIR for those that have lost MSHO/integrated SNP:
These cases need to be managed on an individual case by case basis with the MN Department of Commerce. Call the Consumer Response Line and explain the situation to the Commerce staff. If this issue is not able to be resolved, contact Kelli Jo Greiner directly.