Situations in Which Guaranteed Issue Rights Apply
You may have a guaranteed issue right to buy a Medigap policy in the
following situations involving health coverage changes.
- Your Medicare + Choice plan or PACE program coverage ends because
the plan is leaving the Medicare Program or stops giving care in your
area.
- Your Employer Group Health Plan (EGHP) coverage ends.
- Your health coverage ends because you move out of the plan's
service area.
- You join a Medicare + Choice plan or PACE program when you are first
eligible for Medicare at age 65. Within the first year of joining, you
decide you want to leave.
- You drop a Medigap policy to join a Medicare + Choice plan, Medicare
SELECT policy, or PACE program for the first time. You then decide,
after being in the plan less than 1 year, that you want to leave.
- Your Medigap insurance company goes bankrupt and you lose your coverage,
or your Medigap policy coverage ends through no fault of your own.
- You cancel your current Medicare + Choice plan, Medicare SELECT policy,
or Medigap policy because the insurance company has committed fraud.
For example, the marketing materials were misleading, or quality standards
were not met.
Let's take a closer look at each of these situations. |
