Medigap policies are a form of private supplemental insurance that pay for part or all of Medicare’s coinsurance and deductibles. Certain policies also cover health care costs that Medicare doesn’t cover, such as emergency medical care in foreign countries, and excess charges from a provider who does not accept assignment. Medigap policies do not restrict you to a network of providers and facilities, like many Medicare Advantage plans do. Therefore, with a Medigap policy, you can see any doctor or use any hospital that accepts Medicare. These factors make Medigaps an attractive way to supplement Medicare, but companies selling them can require a health screening and can deny coverage due to present or past health conditions. There are certain situations, however, when people are guaranteed the right to purchase a Medigap policy without a health screening or waiting period for a limited period of time. (Note: guaranteed issue rights are limited to Plans A, B, C, F and high deductible F, K, L, M or N.) The rights triggered by these situations are called Guaranteed Issue rights.
One of these guaranteed issue rights is for people in Medicare Advantage (MA) plans. The guarantee issue is triggered if their plan increases their premium, increases their cost-sharing, reduces their benefits or terminates one of their providers. These people have the right to buy a Medigap policy, BUT only from the same MA organization in which they are enrolled, if it sells one, or from the parent company or network that contracts with the MA plan. If the MA plan does not sell a Medigap policy, they still have the right to buy a Medigap from any other company IF their MA plan increased their premium or copayments by 15% or more, reduced their benefits, or terminated its relationship with their medical provider treating them.
During this year’s Annual Election Period, we received several complaints of beneficiaries exercising this guaranteed issue right and being refused a policy. It seems that some Medicare Advantage plans and companies selling Medigap plans are not aware of this right. While we are currently working closely with the California Department of Insurance to correct these cases, we want to hear from you if you, a family member or your clients are experiencing any difficulty in exercising these guaranteed issue rights. Please contact us at firstname.lastname@example.org or 916-231-5110. You can also contact your local Health Insurance Counseling and Advocacy Program (HICAP) online or at 1-800-434-0222. They provide free, unbiased individual counseling on Medicare, options for supplementing Medicare and your entitled rights and benefits.
For more information on guaranteed issue rights as well as open enrollment rights to buy a Medigap policy, see our website section, Your Rights to Buy a Medigap Policy.