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What is “Guaranteed-Issue” and Why Is It so Important?

guaranteed issueIn many of my blogs about Medicare supplement plans, you’ll notice I use the words “guaranteed-issue” quite frequently. But it’s important to understand what it means, and how not taking advantage of a guaranteed-issue Medicare supplement plan could end up costing you money in the long run.

During your Medicare initial enrollment period, you have six months to sign up for a guaranteed-issue Medicare supplement plan. This enrollment period begins the month you turn 65 and are enrolled in Medicare Part A and B and ends six months later.

Guaranteed-issue means you can’t be denied coverage due to any pre-existing conditions. Your initial enrollment period is the only time you’ll have this guarantee-issue option.

What If I Wait to Sign Up for a Medicare Supplement Plan?

Waiting to sign up for a plan could be risky. If you try to sign up for a Medicare supplement plan after your initial enrollment period has passed, you’ll have to go through underwriting – answering a series of health questions, and disclosing any pre-existing conditions you have. Certain medical conditions such as cancer, heart disease or diabetes could result in your application being denied.

If you sign up for a Medicare supplement plan during your initial enrollment period and decide to switch to a different plan later, or switch to a Medicare Advantage plan and decide to switch back, you’ll also be subject to underwriting. So be sure to take this into consideration when changing plans.

What are My Options if I Am Outside My Medicare Initial Enrollment Period and Don’t Qualify for a Medicare Supplement Plan

If you’re outside your Medicare initial enrollment period, guaranteed-issue plans are not available. If your application for a Medicare supplement plan is denied due to health reasons, you still have other options – a Medicare Advantage plan. Medicare Advantage plans are usually available at low or $0 premiums – you just pay your Part B premium. Medicare Advantage plans:

> Limit your annual out-of-pocket costs
> Provide benefits for vision, dental, and hearing (some plans)
> Offer $0 cost gym memberships through the SilverSneakers Program (some plans)
> Usually work by charging copays, rather than deductibles and coinsurance
> Include prescription coverage

One thing to consider when looking at Medicare Advantage plans is the provider network. Each plan has its own network of doctors, which is somewhat limited compared to the number of physicians who participate with original Medicare. If you have physicians you see on a regular basis, you’ll want to be sure they participate with your plan.

Because prescription coverage is included, you’ll want to confirm that any medications you take are part of your plan’s formulary – or list of covered medicines.

Do you have any questions about guaranteed-issue Medicare supplement plans? Do you have any experiences you would like to share or advice for other readers?

Wiley Long

Wiley Long

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.
Wiley Long

 

 
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