Medicare Answers: When Is a Medicare Beneficiary Eligible for Guaranteed Issue MS and MA Plans?

  • Originally published November 5, 2013 , last updated December 23, 2014
  • Medicare
Medicare Answers: When Is a Medicare Beneficiary Eligible for Guaranteed Issue MS and MA Plans?

This week’s Medicare Answers addresses eligibility timing for guaranteed issue Medicare Supplement and Medicare Advantage plans. If you have a Medicare question, email AskRoger@SeniorMarketSales.com.

William asks:

Are all Medicare beneficiaries eligible for guaranteed issue Medicare Supplement plans during AEP? … (Or), when is a Medicare beneficiary eligible for guaranteed issue Medicare Supplement and Medicare Advantage plans?

William,

Generally, Medicare Supplement plans are always guaranteed issue if a person loses coverage through no fault of his or her own. Med Supp renewals also are guaranteed for life. In other words, you cannot lose your coverage for any reason as long as you pay your premiums.

Medicare Advantage beneficiaries, however, are guaranteed coverage for only 12 months. Medicare Advantage plans can choose not to renew their contracts with Medicare each year, meaning they can drop beneficiaries. The number of Medicare Supplement enrollments spike in the fourth quarter each year because individuals can switch from Medicare Advantage to Medicare Supplement. People on Medicare Advantage have the right to non-renew or change their coverage every year during the annual enrollment period (AEP). (This year the Centers for Medicare and Medicaid Services changed the name of the AEP to open enrollment period, OEP — as if things weren’t complicated enough!) While many agents think the OEP exists so people can sign up for Medicare Supplement, this annual enrollment time is mainly for Medicare Advantage.

Medicare Supplement is guaranteed issue at other times as well. According to Medicare.gov, some of these include:

  1. You are in a Medicare Advantage plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.
  2. You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
  3. 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 decide you want to switch to Original Medicare. (This case is considered a “trial right,” giving beneficiaries a right to try a Medicare Advantage Plan and still buy a Medigap policy if they change their mind.)
  4. You dropped a Medicare Supplement policy to join a Medicare Advantage plan (or to switch to a Medicare SELECT policy) for the first time, you have been in the plan less than a year, and you want to switch back. (This case also is considered a “trial right.”)
  5. Your Medicare Supplement insurance company goes bankrupt and you lose your coverage, or your Medicare Supplement policy coverage otherwise ends through no fault of your own.
  6. You leave a Medicare Advantage plan or drop Medicare Supplement policy because the company hasn't followed the rules, or it misled you.
  7. You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy's service area.
  8. William, if you have clients wanting to leave their Medicare Advantage plan, please note that your company underwriting cannot issue the policy without proof of disenrollment.

Proof of disenrollment requires your client to:

  • Complete the MA section on the Medicare Supplement application; and
  • Send ONE of the following with the application:
    • A copy of the applicant’s MA plan termination notice
    • A copy of the applicant’s plan termination notice to company
    • Image of the insurance ID card (only allowed if MA plan is being terminated