Medigap Guaranteed Issue Rights
Understand when you can enroll in or switch Medigap plans without medical underwriting or risk of denial.
What Are Guaranteed Issue Rights?
The 6-Month Open Enrollment Period (Primary Window)
Your strongest guaranteed issue right occurs during your Medigap Open Enrollment Period, which:
- Begins the month you turn 65 and are enrolled in Medicare Part B
- Lasts for 6 months
- Allows you to buy any Medigap policy sold in your state
- Prevents insurance companies from charging you more or denying coverage due to health problems
- Prevents insurance companies from making you wait for coverage to start (no pre-existing condition waiting period)
Special Guaranteed Issue Situations
Even after your initial enrollment period, you may have guaranteed issue rights in these specific situations:
1. Leaving a Medicare Advantage Plan
You have guaranteed issue rights if:
- You enrolled in Medicare Advantage when you were first eligible for Medicare Part A at 65, and within the first year you decide to switch to Original Medicare
- Your Medicare Advantage plan is leaving Medicare or stops providing care in your area
- You move out of your plan's service area
- The plan violated its contract or misled you
Available Plans: You can buy Medigap Plans A, B, C, D, F*, G, K, L, M, or N (*if eligible for Plan F).
Timeframe: You have 63 days from when your Medicare Advantage coverage ends to apply.
2. Employer or Union Coverage Ending
You have guaranteed issue rights if:
- You have coverage through your (or your spouse's) current or former employer or union
- That coverage is ending or has ended
Available Plans: Plans A, B, C, D, F*, G, K, L, M, or N.
Timeframe: You have 63 days from when the coverage ends.
3. Medigap Policy Ends (Not Your Fault)
You have guaranteed issue rights if:
- Your Medigap insurance company goes bankrupt or becomes insolvent
- Your Medigap policy ends through no fault of your own
- The insurance company hasn't followed the rules
Available Plans: Plans A, B, C, D, F*, G, K, L, M, or N.
4. PACE Program or Demonstration Project Ending
You have guaranteed issue rights if:
- You're leaving a Program of All-Inclusive Care for the Elderly (PACE)
- You're in a Medicare SELECT policy and move out of the service area
- You enrolled in a Medicare demonstration or pilot program that's ending
Timeframe: Generally 63 days from when coverage ends.
State-Specific Protections
Some states offer additional guaranteed issue protections beyond federal requirements:
- California: Annual birthday rule allowing one-time plan changes within 30 days of your birthday
- Oregon: Annual 30-day period to change Medigap plans
- Missouri: 6-month open enrollment every year for those 65+
- Several states: Prohibit medical underwriting entirely after your initial enrollment period
Check with your state's insurance department for specific protections in your area.
What If I Don't Have Guaranteed Issue Rights?
If you apply for Medigap outside of a guaranteed issue situation:
- Medical Underwriting: The insurance company can review your medical history
- Higher Premiums: You may be charged more based on health conditions
- Coverage Denial: The company can refuse to sell you a policy
- Pre-existing Condition Wait: Up to 6 months before certain conditions are covered
Taking Action
Need Help Understanding Your Options?
Contact your State Health Insurance Assistance Program (SHIP) for free, personalized counseling about Medigap enrollment and guaranteed issue rights.
Find Your Local SHIP