This guest blog post was written by Jagger Esch, President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate them on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.
Understanding Guaranteed Issue Rights
Medicare beneficiaries are often unaware of their healthcare rights. As an agent, explaining rights to clients is to be expected. In different situations, Guaranteed Issue (GI) rights have different conditions.
For instance, a client becomes Medicare eligible due to age. Whereas in other circumstances a client may become eligible due to losing previous coverage.
Either way, understanding the GI requirements is important for all Medicare agents, carriers, doctors, and healthcare providers. Providing true and up-to-date information is what makes an agent credible and resourceful.
In some situations, insurance carriers must provide or offer certain Medigap policies. Under these policies, clients have Guaranteed Issue rights otherwise known as Medigap protections.
What GI Rights Mean
GI rights mean carriers must sell Medigap policies and cover all of a client’s pre-existing health conditions. During this time, insurance companies can’t charge a client more for Medigap plan due to past or current health issues. It’s not unheard of for insurance companies to deny a Medigap policy to a client or charge more due to health conditions. Carriers must follow GI guidelines and approve policies.
Clients have GI rights when they have changes in any other health coverage out of their control. For example, if a client loses coverage due to moving out of the area. Additionally, patients have GI rights when they enroll during the Open Enrollment Period (OEP).
Sometimes a client has a “trial right” to test out a Medicare Advantage Plan (Part C). In this case, if they change their mind, they can still buy a Medigap plan.
Items Your Client Needs to Have
Medicare beneficiaries are often unaware of the documents they need to ensure a smooth transition when purchasing supplement insurance. Talk to your client about the important items they may need before finding the right Medigap policy.
Clients should keep copies of any letters, notices, emails, and/or claim denials with their name on it as proof of coverage termination. Be sure to mention the importance of keeping the envelopes these papers came in. Envelopes can act as a timestamp of when they were sent.
GI Rights When a Client Loses Coverage
Clients may have Guaranteed Issue rights to purchase supplement insurance plans when they lose healthcare coverage. Some Medigap applications require proof of GI rights. In this case, clients may need to send carriers a copy of any notices or claim denials about coverage termination. Having the proper documents help prove they’re protected under the GI rights.
If a plan terminates coverage in your client’s service area, they lose coverage by default—this is out of their control. Furthermore, a GI window is given in which your client may purchase certain Medigap plans.
During this window, beneficiaries have up to 63 days after losing healthcare coverage to select a new plan under GI regulations. Agents must inform clients that Medicare supplement GI rules are different in each state. Most states require an involuntary loss of coverage to qualify.
Proof of GI Rights & When You're Applicable for GI Rights
GI windows are available only for certain circumstances in most states. Clients need to keep records to help prove they qualify.
For instance, if a clients’ employer healthcare coverage ends, they’ll receive a creditable coverage letter from the company’s insurance provider. Letters should come in the mail within 2 weeks from the last date of health insurance coverage.
Inform your client to keep this letter in a safe place. The same is true for clients that leave or lost coverage from a Medicare Advantage plan. When looking for a new policy, your client can use their termination letters to prove GI rights apply.
GI Rights When Moving to a New Service Area
Medicare Supplement insurance and Medigap plans don’t offer coverage in all regions. If a client moves to an area where the current plan isn't available, GI applies.
Clients must first return to Original Medicare when they move to another state. However, if your client decides they want a Medigap policy instead of their current Medicare Advantage plan, GI rights won't apply.
Clients seeking a Medigap plan for coverage can choose from Plans A, B, C, F, K, and L. As each plan offers different levels of coverage, make sure to compare plans so your client gets the most benefits possible. Although, first-dollar coverage Plans F and C are going away come 2020, including HDF.
However, we anticipate that the new High Deductible Plan G, that will be introduced in 2020 to replace HDF, will be a Guaranteed Issue plan.
GI Rights When a Client Ages
Most individuals qualify for Medicare coverage during the month of their 65th birthday. When clients enroll in Medigap during OEP, they can't be denied coverage due to health conditions.
Rates can vary because of your client's gender, age, smoker status, and location. Give your clients the best available rate by comparing policies in their service area.
When clients miss OEP, they may purchase a Medicare Supplement plan with Guaranteed Issue rights. If a beneficiary is 65 or older, they have GI rights within 63 days of healthcare coverage ending.
Companies sometimes make beneficiaries wait for a period before coverage begins. GI rights prevent insurance companies from putting your client on a waiting period for coverage.
When clients join an MA plan during initial eligibility for Medicare, then decide to unenroll in the plan within 12 months, GI rights may apply.
The Cancellation of a Medicare Supplement Policy
Clients can test a new supplement insurance plan for the first 30 days. If a Medigap plan doesn’t suit a client’s needs, they may cancel within that time for a full refund.
On the other hand, clients may cancel a policy at any time after the initial 30 days. Make sure to warn clients when doing so. Some service areas won't allow beneficiaries to purchase another policy. Even worse, some companies overcharge due to health reasons.
Not all Medicare beneficiaries qualify for GI. However, it's important to keep current and prospective clients properly educated about their rights.
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