Your Medicare Advantage plan is leaving your county, so now you want to switch to a Medigap policy, but you're worried your health history will get you turned down. In a set of federally defined situations, it can't: the insurance company has to sell you a policy, and it can't charge you extra because of your health. Those situations are your guaranteed issue rights.

In This Guide

What Medigap Guaranteed Issue Rights Actually Mean

Let's start with the plain version. Guaranteed issue rights are the situations where an insurance company can't deny you a Medigap policy. Medicare also calls them "Medigap protections," and the two names mean the same thing.

When you have a guaranteed issue right, three things are true at once. The insurer must sell you a Medigap policy it offers. It can't charge you more because of past or present health problems. And it can't make you wait out a pre-existing-condition period before your coverage counts. So your blood pressure, your last surgery, that diagnosis from three years ago, none of it can be used against you here.

Now, why does this matter so much? Most of the time, buying a Medigap policy means going through medical underwriting, where the insurer looks at your health and can say no or charge you more. The big exception is your one-time 6-month Medigap Open Enrollment Period, which starts the first month you're both 65 or older and enrolled in Part B. Guaranteed issue rights are the other exception, and they mostly show up after that six-month window has closed. That's the whole point of knowing them: they're your second chance to get in without a health screening.

When Your Medigap Guaranteed Issue Rights Kick In

Guaranteed issue isn't something you get just because you'd like a Medigap policy. It's tied to specific events, almost all of them involving other coverage you're losing. Here are the main federal triggers.

Your Medicare Advantage plan leaves or you move away

If your Medicare Advantage plan leaves Medicare, stops serving your area, or you move out of its service area, you get a guaranteed issue right to buy a Medigap policy. This is the classic one. Plans drop counties every year, and members find out in the fall that their plan won't exist come January. If that's you, you don't have to accept whatever's left; you can move to Original Medicare and pick up a Medigap policy without a health screening.

You lose employer or union retiree coverage

If you have group health coverage through an employer or union that pays after Medicare, and that coverage ends, you get a guaranteed issue right. Retiree plans get cut, companies restructure, and a surviving spouse can lose coverage that was tied to the other person's job. When that happens, the door to a Medigap policy opens without underwriting.

Your Medigap insurer fails you

Two related situations here. If your Medigap insurance company goes bankrupt or otherwise ends your coverage through no fault of your own, you get a guaranteed issue right to buy a new policy. And if the company misled you or broke the rules, that counts too. You shouldn't lose your protections because the insurer, not you, dropped the ball.

The 12-month Medicare Advantage trial right

This is the trigger people most often don't realize they have. If you dropped a Medigap policy to join a Medicare Advantage plan for the first time, or you joined Medicare Advantage right when you first signed up for Medicare, you get a trial period. Within the first 12 months, you can switch back to Original Medicare and buy a Medigap policy with guaranteed issue. Think of it as a one-year test drive: try Medicare Advantage, and if it isn't for you, you can back out and land on Medigap without a health review, as long as you do it inside that first year.

The 63-Day Deadline

Here's the number that decides whether any of this helps you: 63 days.

In most guaranteed issue situations, you have to apply for the Medigap policy no later than 63 days after your prior coverage ends. That clock usually starts on the last day your old plan or coverage was in force, not the day you got the letter about it. So the moment you know coverage is ending, start shopping. Waiting until the old plan actually stops can eat most of your window.

The trial right runs on a longer clock, that first 12 months after you joined Medicare Advantage, but the same lesson holds: these are deadlines, not open-ended offers. Once the window closes, an insurer is free to make you go through medical underwriting again, and then your health history is back on the table.

If you can, apply a little early rather than a little late. You can often line up a Medigap policy to start the day your old coverage ends, so you're not left with a gap.

States That Give You More

Everything above is the federal floor. It applies everywhere.

But some states build extra guaranteed issue rights on top of the federal minimums. A handful, for example, let you switch Medigap plans once a year without underwriting, or give you a guaranteed issue window every year around your birthday. The rules and the timing differ from state to state, so the federal list here is your starting point, not the last word. Before you assume you're out of options, check what your own state offers, because it may be more generous than the federal rules alone.

Frequently Asked Questions

Can an insurance company deny me a Medigap policy?

Outside of a guaranteed issue situation, yes. Most of the time an insurer can use medical underwriting to turn you down or charge you more. But when you have a guaranteed issue right, it can't: it must sell you a Medigap policy it offers, can't deny you for your health, and can't add a pre-existing-condition waiting period.

Do guaranteed issue rights cover every Medigap plan?

Guaranteed issue is about the insurer not being able to refuse you or price you by your health, in the specific situations federal law lists. Which particular Medigap policies an insurer must offer you can depend on your situation and your state, so ask the insurer, or your State Health Insurance Assistance Program, exactly which policies your right applies to.

How long do I have to use a guaranteed issue right?

In most situations, 63 days from the day your prior coverage ends. The Medicare Advantage trial right is different: you have the first 12 months after joining Medicare Advantage to switch back and buy a Medigap policy with guaranteed issue. Either way, act early, because the protection disappears when the window closes.

I already have a health condition. Does that matter?

Not for a guaranteed issue right. That's the entire point of it. In these situations the insurer can't charge you more or make you wait because of a pre-existing condition. Outside of one, a health condition can absolutely affect whether you're approved and what you pay.

My state isn't mentioned. Am I stuck with just the federal rights?

The federal triggers apply in every state, so you always have at least those. Some states add more, like an annual or birthday-month window to change Medigap plans without underwriting. The only way to know your state's extras is to check your state's rules directly.

Learn More

MedicareMedigap (Medicare Supplement): How the Lettered Plans WorkMedigap (Medicare Supplement) explained: how the standardized A-N plans work, Plan G vs Plan N, closed C and F plans, and the 6-month guaranteed-issue window. MedicareWhen Is the Medigap Open Enrollment Period? The One Window That MattersYour Medigap Open Enrollment Period is a one-time, 6-month window that starts when you're 65 and on Part B. Buy inside it or you may be turned down later. MedicareSwitching Between Medicare Advantage and Original MedicareLeaving Medicare Advantage? Two 12-month trial rights let you buy Medigap with no health screening. See the windows, the deadlines, and how to switch back. MedicareMedigap and Pre-Existing Conditions: What the Waiting Period Really MeansFederal law caps the Medigap pre-existing condition waiting period at six months, and prior coverage can erase it in your Open Enrollment Period. How it works. MedicareCan You Still Get Medigap Plan F? The 2020 Cutoff ExplainedCan I still get Medigap Plan F? It depends on one date. If you were eligible for Medicare before January 1, 2020, yes. If not, here's what to buy instead. MedicareSuspending Your Medigap Policy When You Qualify for MedicaidIf you get Medicaid, you can suspend your Medigap policy for up to 24 months instead of dropping it, then reinstate it later with no new medical underwriting.

Find personalized help figuring out whether you qualify for a guaranteed issue Medigap policy at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.