December 4, 2017

There’s a lot about Medicare that confuses people, but nothing has caused as much confusion as the term Guaranteed Issue.

Not only do consumers struggle to understand this, but agents get tripped up over it as well.

Guaranteed Issue (GI) and Open Enrollment are so similar, but they’re different. They overlap at times, and it gets downright confusing.

So, for anyone who needs a refresher or is struggling to get things straight, I wanted to explain what they are and how they interact with each other.

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Open Enrollment

We keep open enrollment easy to understand by remembering this simple fact: When you’re signing up for Part B for the first time, you’re in open enrollment.

So, whether you’re 65 and are signing up for Part B or are 70 and have just retired, as long as you’re signing up for Part B for the first time, you’re considered to be in open enrollment.

And I’ll remind you that there’s a federal regulation that exists allowing anyone – regardless of health – to be accepted for any Medicare Supplement.

You can purchase any plan without having to pass any medical underwriting for 6 months.

There are times when you can be in an open enrollment situation while also being in a GI situation. I’ll explain that in the next section.

Guaranteed Issue (GI)

There are also “Guaranteed Issue” situations, where you can only sign up for Plans A, B, C, or F without having to pass medical underwriting.

People usually only go with Plan F, but those other plans are also available since we’re being thorough.

Read more: Plan F Is Dead… Or Is It?

GI situations occur when something happens to the person’s existing insurance. Here are 2 common examples:

  • You’re in a Medicare Advantage Plan, and you move out of the plan’s service area.
  • Your employer’s group health plan is ending. 

In these circumstances, you have a 63-day window to choose a plan.

As you’ve probably guessed, it is possible to be GI and open enrollment at the same time. You might be getting dropped from your employer’s group health plan, so you decide to enroll in Medicare Part B for the first time. Technically, you’re GI and open enrollment.

However, it’s in your best interest (the agent) to always go with open enrollment if you can, because the client can choose from any Medigap plan.

Medicare Advantage Trial Right

One more thing I’d like to go over is the Medicare Advantage trial right, because this happens a ton. There are 2 situations that occur: a person chooses Medicare Advantage during open enrollment, or they switch to Medicare Advantage from their Medigap Plan.

For example, let’s say a person signs up for Medicare Parts A & B. If they choose Medicare Advantage, and they decide they don’t like it within the first 12 months, they can get out of it and go back to Original Medicare. In this scenario, the person is back in open enrollment, and they can get any Med Supp.

Another example is if a person is on a Medigap plan. If they switch to Medicare Advantage, and they decide they don’t like it within the first 12 months, they can go back to their previous Medigap plan. If that plan isn’t available anymore, they are in a Guaranteed Issue situation, which basically means they can get any Plan F.

As with anything, some states are different when it comes to their rules. I’ve come across so many random situations – I feel like I’ve seen it all, and I’d be glad to help you if you have any questions.

However, if I don’t know if something is open enrollment or GI, I can call our underwriters to get an answer for you.

I hope this clears up the confusion, and please don’t hesitate to give me a call if you have a situation you’re unsure of.

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