What it is
Guaranteed issue rights are protections that may require an insurance company to sell you a Medigap plan. In those cases, the company generally cannot refuse you or charge more because of your health history.
Outside of these protections, a company may use medical underwriting. That means it can ask health questions and, in many states, may decline an application or set the price based on your answers.
Guaranteed issue rights are sometimes called Medigap protections. They are different from your Medigap open enrollment period, which is a separate window tied to when you first have Medicare Part B. The rules differ by state and change over time. Plans C, F and high-deductible F are available only to people who became eligible for Medicare before January 1, 2020. Massachusetts, Minnesota and Wisconsin standardize Medigap differently.
How it’s traditionally been approached
People often hear about guaranteed issue rights when something changes. Common examples include losing certain other health coverage, a Medicare Advantage plan ending in your area, or moving out of a plan's service area. Some people also look into these rights after trying a Medicare Advantage plan.
Which plans you can choose, and how long you have to apply, depends on the situation and your state. Some situations may limit you to certain plan letters. Many people keep records such as notices from their old plan, because these notices can show dates and reasons.
Traditionally, people have learned about these rights from Medicare.gov, their State Health Insurance Assistance Program (SHIP), or a licensed agent. Each source can help you check what applies to you. Many people use more than one.
How the right licensed agent may help
A Medigap agent may help you work out whether a guaranteed issue right could apply to your situation. A visit is usually a conversation about what changed, what coverage you had, and what you hope to keep or change. An agent may also explain how Medigap compares with Medicare Advantage, so you can see both sides fairly.
It may help to bring your Medicare card, any notice about your coverage ending, and a list of your doctors and prescriptions. An agent may use these to explain which plans could be open to you. Medigap generally works with any provider nationwide that accepts Medicare, with no network or referrals. Medigap premiums are often higher than Medicare Advantage premiums, and drugs need a separate Part D plan.
Good questions to ask include: Which deadline applies to me? Which plan letters could I choose? How would I confirm this with my state? A Medigap agent cannot promise you will be accepted. Call 1-800-MEDIGAP for more information.
The bigger picture
Insurance changes can be stressful, especially when a deadline is close. Knowing your options may bring some peace of mind. It can also help you plan your budget and feel more confident about seeing the doctors you choose.
Take your time and ask for help when you need it. A trusted family member can sit in on the conversation. If you are also looking for care providers, Providers.plus may be one place to explore.
Keep in mind
- Guaranteed issue rights apply only in certain situations, and the deadlines can be short.
- Rules differ by state and change over time. Confirm current rules with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.
- Only Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans E, H, I and J were discontinued and are not sold today.
- This page is education only, not insurance, legal, tax or medical advice. 1-800-MEDIGAP is not connected with or endorsed by the U.S. government or the federal Medicare program.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
What are guaranteed issue rights for Medigap?
Guaranteed issue rights are protections that may require a company to sell you a Medigap plan despite your health history. They apply only in certain situations, such as losing some kinds of coverage. Rules vary by state, so confirm yours with Medicare.gov or your SHIP.
Is guaranteed issue the same as Medigap open enrollment?
No. Open enrollment is a window tied to when you first have Medicare Part B. Guaranteed issue rights are separate protections that depend on specific events. Both can affect whether a company may use medical underwriting.
When might I have a guaranteed issue right?
You may have one if certain coverage ends or if your Medicare Advantage plan leaves your area. The exact situations and timelines depend on federal and state rules. A licensed agent or your SHIP can help you check your situation.
Can I get Medigap Plan H with guaranteed issue rights?
No. Plan H was discontinued and is not sold today, so guaranteed issue rights cannot be used to buy it. Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible. Plans C and F are available only to people who became eligible before January 1, 2020.
Do guaranteed issue rights apply if I switch from Medicare Advantage to Medigap?
Sometimes, but not always. Some situations give you a right to buy Medigap, while others may allow underwriting. Check your state's rules and the timing before you make a change.
How can a Medigap agent help with guaranteed issue rights?
A Medigap agent may help you understand which rights could apply, which plans might be open to you, and what deadlines to watch. An agent cannot guarantee acceptance. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.