The ABCs of Medicare Supplement Plans

Part five: Medigap Guaranteed issue trial rights and proving you have Medigap guaranteed issue rights

You already know what rights you have once you buy a Aetna Medicare supplement Plan G and in what situations you can apply for a Medigap policy in case you missed the 6-month enrollment period. However, there are a couple more situations in which you can enroll to a Medigap policy outside the 6-moth enrollment period. In this article we will cover these situations, which are related to Medigap guaranteed issue trial rights; what documents you need to prove you have Medigap guaranteed issue rights and advice in case you are in any of the situations.

As it was previously said, the Medigap guaranteed issue rights are the rights you have when applying for a Medigap policy that protects you from being denied coverage, by federal law. It was also said that there are certain situations outside the 6-month Medigap open enrollment period when you may still be able to get a Medigap policy if you are 65 or older, according to Medigap guaranteed issue rights. Along with these situations, there are additional ones in which you can qualify to get a Medigap policy outside the enrollment period. These additional situations are contemplated in the Medigap Guaranteed issue trial rights. Trial rights allow you to buy a Medigap policy or switch back to it during the first year of joining a Medicare Advantage plan or buying a Medicare SELECT policy (a Medigap policy that limits your coverage to a network of doctors and hospitals).

You qualify for these rights in the following situations:

  • You joined a Medicare Advantage plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65 and within the first year of joining, you want to switch back to Original Medicare. In this case, you are able to get any Medicare Supplement Plan available in your state.
  • You dropped a Medigap policy to join a Medicare Advantage plan or buy a Medicare SELECT policy for the first time, and you have been in the plan less than a year and you want to switch back to Medigap. In this case you are able to get the same Medicare Supplement Plan you had before you joined the Medicare Advantage plan or Medicare SELECT policy. If the same insurance company you had before does not sell that plan anymore, you can buy a Medigap Plan A, B, C, F, K, or L that is sold by any other insurance company in your state.

In both cases above, you must apply to the Medigap policy as early as 60 calendar days before the date your coverage will end and no later than 63 calendar days after your coverage ends. There is also the possibility that your rights may last for an extra 12 months under certain circumstances.

Am I able to get a Medicare Supplement Plan if I lost or dropped my health coverage?

If you lose or drop your health coverage, you may have a guaranteed issue right to buy a Medigap policy. In this case you need to prove that you have a guaranteed issue right and in order to do that, you need to send with your Medigap application, a copy of the following documents: any letters, notices, emails and claim denials that have your name on them to prove that your coverage is being terminated with the postmarked envelope these papers come in to prove when they were mailed to you. So make sure you keep all these items when you get Medicare because they could be really useful in the future. Please take into consideration that the situations and rights above are from federal law and depending on the state you are in, there could be more rights.