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Are Medicare Advantage Plans Guaranteed Issue?

What does 'guaranteed issue' mean and do Medicare Advantage plans have guaranteed issue?

3 mins read
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What is a guaranteed issue policy?

“Guaranteed issue” means that the insurance company guarantees that it will issue you a policy at the best rate without any underwriting for health or preexisting conditions. You cannot be denied a policy.

The concept of guaranteed issue only applies to Medicare Supplement plans (or ‘Medigap’) where you get private supplemental Medicare insurance from a private insurance company that works with Original Medicare.

This concept doesn’t apply to Medicare Advantage because unlike Medicare Supplement insurance which is ‘pure’ private insurance (i.e., not federally subsidized), Medicare Advantage plans are provided by private insurance companies who are contracted directly with the federal government and are paid by the government to deliver you your Medicare services.

In other words because they are paid by the federal government, they can not discriminate or deny coverage – everyone eligible for Medicare is allowed to enroll into a Medicare Advantage plan that is available in their area.

When can you enroll in Medicare Supplement with a guarantee issue period?

As with all things Medicare there are windows of time when you can sign up or make changes. In order to qualify for a guaranteed issue Medicare Supplement plan, you must enroll within the first six months after signing up for Medicare Part B. This is called your Medicare Supplement Open Enrollment Period.

In most states, this is your only chance to get a Medicare Supplement plan with guaranteed issue. There are also some states that have local state rules that provide additional opportunities to enroll with guaranteed issue outside your Medicare Supplement Open Enrollment Period.

Why is guaranteed issue a big deal?

If you’re interested in buying a Medicare Supplement plan and are in your eligibility window for a guaranteed issue policy and happen to have a health condition, this may be the only time to you are able to obtain a Medicare Supplement policy at the best rate. Depending on how serious your health condition is, it might be your only time to get a policy at all. Medicare Supplement insurance companies are not required to issue a policy once your “guaranteed issue window” is over.

If a Medicare Supplement policy is something you want, don’t miss your window to apply.

How is this similar to other insurance products?

In some ways, a guaranteed issue policy is not unlike the insurance that you probably already have that protects your home or auto. Like those policies, you buy a guaranteed issue healthcare policy directly from an insurance company. But other considerations come into play.

There are specific features and benefits to guaranteed healthcare policies that set them apart from those other forms of insurance. If you sign up for a guaranteed issue policy within six months after you sign up for Medicare Part B, the insurance company that issues the policy:

  • Cannot ask you about any preexisting medical conditions or diseases and deny you coverage
  • Must offer you the standard lowest price for your policy and cannot charge you higher rates because you don’t fit their underwriting model
  • Cannot cancel your policy after you are enrolled unless you fail to pay your premiums

So, Are Medicare Advantage Plans Guaranteed Issue or not?

In some ways, Medicare Advantage plans are guaranteed issue. They are overseen by the government, even though your care coverage is administered by a private company. Anyone who wants to sign up for a Medicare Advantage plan (during one of the available enrollment windows) will be issued a policy with no questions asked and no health underwriting.

Keep in mind Medicare Advantage Plans and Medicare Supplement Plans provide medical coverage in different ways. You can learn more about the different cost/payment structures and how the plans work in this video.

In summary: How to make sure you get the best Medicare coverage you want

  • Be sure to enroll during your initial enrollment period. It’s the only way to avoid having additional fees or penalties tacked on later. Also, it’s a way to protect yourself against the possibility that in the future, underwriters at the insurance companies will find a way to increase the cost of their policies or deny you coverage.
  • If you can afford to pay for a Medicare Supplement (Medigap) plan, don’t wait to sign up for it. When you first enroll in Medicare Part B, set up the supplemental coverage and keep it in place.
  • Think about any future medical conditions, costs, and concerns when you first enroll at 65.
  • Pay your premiums. Your coverage in a Medicare Supplement plan will stop if you don’t pay your premiums. If your policy lapses there is no guarantee the insurance company will reinstate you and if they do, they can raise your premiums based on underwriting standards.

CoverRight is on a mission to make the Medicare plan selection process easy to understand and help you find the best Medicare plans suited to your specific situation.

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Barry Lenson

Barry’s is an experienced writer who's most recent book projects have included "The Digital Health Revolution" and "Connecting Health Care," for which he served as writer and editor for the author Kevin Pereau. Barry’s own books include the self-help bestseller "Good Stress, Bad Stress." Barry writes blogs for Tortal Training, Ingage Consulting, Specialty Metals Smelters and Refiners, and other clients.

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