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Guaranteed Issue / Open Enrollment Period
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Guaranteed Issue / Open Enrollment Period
Toll Free Help Line 888-825-0689
Guaranteed Issue and Open Enrollment are
important to you.
You should know your rights
Timing of the Open Enrollment Period
The CMS bulletin clarifies that the 6 month Medigap open enrollment period begins for an
individual on the first day of the first month after he/she has both a) attained age 65 and
b) become entitled to Medicare Part B benefits.
An individual attains age 65 on the first day of the month in which the individual ’s 65th
birthday falls. For example, an individual whose 65th birthday is October 15, 2003 will be
deemed to have attained age 65 on October 1, 2003. Exception: For an individual whose
birthday falls on the first day of the month, he/she is deemed to have attained age 65 on
the first day of the previous month. For example, an individual whose 65th birthday is
October 1, 2003 will be deemed to have attained age 65 on September 1, 2003.
An individual becomes entitled to Medicare Part B benefits when he/she has been
accepted into the Medicare program. An individual’s Medicare card will indicate the date
on which he/she became entitled to Part B benefits. (The date on which an individual
applies for Medicare is generally not the same as the date on which he/she becomes
entitled to benefits.)
GUARANTEED ISSUE:
If you are losing your employer group health insurance coverage, through no fault or
decision of your own, you may be entitled to purchase a Medicare supplement policy
without having to answer underwriting (health) questions during the first 63 days after you
receive notice that your group policy is going to end, up to 63 days after the group policy
has ended. This entitlement is referred to as "guarantee issue" and is called a
"guaranteed issue" period. "Guarantee issue" means you have the right to enroll into a
Medicare supplement policy within a 63-day period and the insurance company cannot
refuse to issue a policy to you, regardless of your health. However, a prescription drug
rider can be denied in a guaranteed issue period. (In an open enrollment period the
prescription drug rider cannot be denied).
EVENTS THAT MAY TRIGGER A GUARANTEED ISSUE PERIOD:
1. You are enrolled in an employer group health benefit plan, and the plan terminates or
ceases to provide some or all health benefits to you.
2. You are currently enrolled in a Medicare Plus Choice or Medicare select health
insurance plan and you are moving from their service area. You should keep your current
plan until you actually obtain new insurance in your new location. You will be covered for
emergency and urgently needed care under your old policy. The new company has to
issue a policy to you and you will not have to answer any health questions. In most
circumstances, you will not have to serve a per-existing condition waiting period. Call a
counselor to discuss your special circumstances.
3. You are in a trial period with a Part C Medicare Plus Choice plan and want to purchase
a regular Medicare supplement insurance policy.
CREDITABLE COVERAGE:
Creditable Coverage is the term given to the time or "credit" you are granted for the time
you have been enrolled in and covered by qualified health insurance coverage. Having
creditable coverage means you will not have to serve a per-existing condition waiting
period. Creditable coverage only applies in situations where you are losing employer
group health coverage and you want to go into the HIRSP plan or into another employer
group plan. For the HIRSP plan you must have had qualified coverage for the previous 18
months. There cannot be more than 63 days between the time your prior coverage ends
and the day you apply for the HIRSP coverage.
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