The answer is, “Not if you are new to Medicare.” Medicare made a deal and every insurance carrier that o?ers Medigap Supplements must go along with that deal. Here’s the deal. There are certain circumstances we will discuss that result in insurance companies providing Medigap with Guaranteed Issue.
This means that everyone who ?ts one of these circumstances is entitled to any Medigap letter plan they want, with any carrier they want, without any underwriting. There are no medical questions of any kind asked. You cannot be charged a higher premium based on their health. It doesn’t matter what medical issues that someone has, they are approved for their Medigap supplement. Period.
The largest part of that special guaranteed group are those people who ?rst become eligible for Medicare, but there are others as well who are entitled to a Medigap supplement with no underwriting we will come to in a minute.
The key to being considered new to Medicare for guaranteed issue purposes, is being new to the Part B portion of Medicare.
Many people delay Medicare while they are covered by their Group Health Insurance past age 65. When those people retire, for instance at age 69, or at age 96 for that matter, they are considered new to Medicare and enjoy the guarantee of Medigap coverage without answering any medical questions. Someone will pay a little more for their premium based only on their age, if they are older than 65, but they will not pay more based on their health condition.
Other people that qualify for guaranteed issue, without underwriting, include those who move out of their plan’s service area when they are on a Medicare Advantage plan, those who lose their Group Health coverage, and people on a Medicare Advantage plan that was discontinues.
Another important guaranteed issue circumstance is Trial Rights. Those who join a Medicare Advantage plan for the ?rst time get one year to change their mind and switch to Original Medicare with a guaranteed Medigap supplement anytime during that ?rst 12 months on a Medicare Advantage plan. However, you only receive trial rights if you enroll in a Medicare Advantage plan at age 65 right at the beginning, in the ?rst month that you are eligible for Medicare.
For anyone who does not fall into the guaranteed issue category they can still get a Medigap supplement but only if they are accepted through underwriting. The good news is there are no blood tests or doctor exams. You do, however, have to answer “No” to a series of questions pertaining to a large number of medical conditions, and if you are currently having treatments or have surgery upcoming this will likely disqualify you, if you’re being underwritten, as well. Another area of concern that carriers will review is your prescription list.
In essence, if you don’t have guaranteed issue, and carriers don’t have to take you, then in this situation insurance companies are making a business decision. That’s why I often say to clients, “If you think you want Original Medicare with a Medigap supplement enroll in one when you first join Medicare and you know that you have Guaranteed Issue.” Too many times, I see clients who really want Original Medicare later on but cannot make the switch from Medicare Advantage because they can’t pass underwriting. Healthy today does not guarantee healthy tomorrow.
