Medigap Guaranteed Issue Rights: When You Can Buy
A Medigap guaranteed issue right is a short window in which an insurance company must sell you a Medicare Supplement policy, cover your pre-existing conditions and charge you no more because of your health. It applies in a limited set of situations, such as losing a Medicare Advantage plan or employer coverage, and in most of them you have 63 days to apply. Outside those windows, the insurer can ask health questions and say no. Here is how to tell whether you have a right, how to use it, and where to be careful.
TL;DR
- Guaranteed issue means no medical underwriting: the insurer must sell you the policy, cover pre-existing conditions and not raise your price for your health.
- Your first guaranteed window is the six-month Medigap Open Enrollment Period that starts the month you are 65 or older and enrolled in Part B. Later rights depend on losing certain coverage.
- In most situations you must apply no later than 63 days after your old coverage ends. Keep your termination notice as proof.
- Medigap is not guaranteed issue by default. Only Connecticut, Massachusetts, Maine and New York give all beneficiaries 65 and older year-round or annual protection, and everywhere else a later application can be denied.
- Rules for people under 65 depend on the state.
Table of Contents
- What guaranteed issue means for Medigap
- Your first window: Medigap Open Enrollment
- Situations that give you a guaranteed issue right later
- The 63-day rule and how to avoid a gap
- Which Medigap plans you can choose
- What happens if you have no guaranteed issue right
- State rules can go further than federal law
- Common mistakes that cost people their window
- How Almond Insurance can help
- FAQ
- Sources
What guaranteed issue means for Medigap
Medigap policies are sold by private insurers to fill in what Original Medicare leaves behind: deductibles, coinsurance and some copayments. Because the insurer takes on that cost, it normally wants to know your health history before it sells you a policy. That process is called medical underwriting.
Guaranteed issue rights, which Medicare also calls Medigap protections, are the limited situations where an insurance company cannot deny you a policy. According to Medicare’s own guide to choosing a Medigap policy, the insurer must sell you a policy, cover your pre-existing conditions and cannot charge you more because of your health status.
So the short answer to a common question: no, Medicare Supplement plans are not guaranteed issue across the board. Outside a protected window, KFF reports that insurers in most states may turn you down for conditions such as Alzheimer’s, cancer or diabetes with complications. The rest of this article is about making sure you are inside a window when you apply.
Your first window: Medigap Open Enrollment
Federal law gives you one guaranteed window that almost everyone gets. Medicare describes it as a one-time, six-month Medigap Open Enrollment Period. It begins the first month you are 65 or older and enrolled in Part B. During it, insurers cannot deny you coverage or use medical underwriting.
This is the single most valuable window, because it requires no special event. It is also the easiest to miss. Many people sign up for Part B at 65, spend a few months on Original Medicare, and later decide they want a supplement. If that decision lands after month six and they have developed a health condition, the insurer can decline them.
If you are still working at 65 and delaying Part B, the clock does not start until Part B starts. Our guide to Medicare enrollment periods shows how the Part B timeline and the Medigap timeline fit together, and our piece on COBRA versus Medicare covers a common trap for people leaving a job.
Situations that give you a guaranteed issue right later
After open enrollment ends, you generally need a qualifying event. Medicare lists them in its Choosing a Medigap Policy guide. The ones readers ask about most are below.
| Situation | What it means in practice |
|---|---|
| Your Medicare Advantage plan leaves Medicare or stops providing care in your area | The plan ends through no choice of yours, so you can move to Original Medicare and buy a Medigap policy |
| You move out of your Medicare Advantage plan’s service area | A move can open a right even if the plan itself continues |
| Your employer group health plan that pays after Medicare ends | Retiree or similar coverage that supplemented Medicare stops |
| Your Medicare SELECT policy ends because you move out of its area | You can buy a different Medigap policy |
| A trial right | You joined a Medicare Advantage plan when first eligible at 65 and leave it within the first year, or you dropped a Medigap policy to try Advantage and want to go back |
| Your Medigap insurer fails you | The company goes bankrupt, ends your coverage through no fault of your own, or misled you |
Two points deserve attention.
The event matters, not just the wish to switch. Being unhappy with your Advantage plan’s network does not by itself create a right. Leaving because the plan is terminating or because you moved out of its area does. The trial right is the exception, and it is time limited.
The trial right expires. KFF notes that federal trial rights often run out after 12 months, which limits how long a person on Medicare Advantage can count on switching back with guaranteed issue protection. After that, a person who wants a supplement may face underwriting in most states.
The 63-day rule and how to avoid a gap
For most federal guaranteed issue situations, you must apply for a Medigap policy no more than 63 days after your previous coverage ends. Treat that as a hard deadline and count from the date coverage ends, not the date you received a letter.
You can also apply early. Medicare says you can often apply for a guaranteed-issue policy before your current coverage ends, and the policy can start the day the old coverage stops. The guidance for people leaving a Medicare Advantage plan is to apply before that coverage ends and ask that the Medigap policy start when it does, so there is no gap.
A simple order of operations:
- Find your end date. Look at the termination notice from your plan or employer.
- Save the proof. Keep the notice, and any claim denial letters, in one folder. The insurer may ask for them to confirm your right.
- Choose a policy letter. See the next section for what you may be entitled to.
- Apply inside the window. Ask for an effective date that matches the end of your old coverage.
- Do not cancel the old plan first. Make sure the new policy is approved before you let the old coverage lapse, unless the old plan is ending anyway.
If you are on Medicare Advantage and your plan is leaving the area, you will usually get notice in the fall, so the planning window is the same stretch when annual plan changes are announced. A short annual coverage review is a good moment to check whether any notice you received creates a right.
Which Medigap plans you can choose
A guaranteed issue right does not always let you pick any letter plan. Under federal rules summarized in Medicare’s guide, you are generally entitled to buy Plans A, B, C, D, F or G, though Plans C and F are available only to people who were eligible for Medicare before January 1, 2020. Insurers cannot use medical underwriting for these policies when you are exercising a valid right, refuse to sell, or exclude pre-existing conditions.
The Plan C and F limit comes from a federal law called MACRA, which prohibited selling those plans to newly eligible beneficiaries to end first-dollar coverage in Medigap. For most people turning 65 today, Plan G is the closest comparable option. The exact set of plans available in a particular situation can differ, so confirm which policies you may buy before you apply.
A caution on pre-existing conditions: federal protection is strong, but KFF’s policy experts point out that an insurer may impose a six-month waiting period for pre-existing conditions if you did not have enough continuous creditable coverage, even in some guaranteed issue windows. If you have an ongoing condition, ask the insurer in writing how it treats your situation before you finalize.
What happens if you have no guaranteed issue right
You can still apply for Medigap. You just go through underwriting. Insurers can deny you or charge more based on your health history, and KFF reports that in all but four states people on Medicare may be refused or charged higher premiums for pre-existing conditions if they apply outside a guaranteed issue window.
That is the risk behind leaving Original Medicare for an Advantage plan. Going into Advantage is easy. Coming back and buying a supplement can be hard unless you have a right. If you are weighing the two, read our comparison of Medicare Advantage and Medicare Supplement before you switch.
Some people avoid underwriting by timing alone: applying during the open enrollment months, or applying within 63 days of a qualifying loss of coverage. Others live in a state with broader rules, covered next.
State rules can go further than federal law
States may add protections beyond the federal minimum, so where you live changes your options. Per KFF, Connecticut, Massachusetts, Maine and New York are the only states that require continuous or annual guaranteed issue for all beneficiaries 65 and older, regardless of health. Some other states have birthday rules or their own annual windows, and Rhode Island and Delaware enacted annual guaranteed issue periods for Medicare Advantage enrollees 65 and older in 2025. Those newer rules tend to be limited to certain ages or enrollment types, not unlimited.
People under 65
Federal law does not require guaranteed issue for people under 65 who have Medicare because of a disability. KFF found that 36 states require insurers to offer at least one Medigap policy to under-65 beneficiaries. If you are under 65 and on Medicare, the availability and price of a policy depend heavily on your state, so check with your state’s insurance department or a local advisor.
If you live in Northern Illinois or Southern Wisconsin
Neither Illinois nor Wisconsin appears among the four states with continuous or annual guaranteed issue for everyone 65 and older, so the federal windows described above are the ones to plan around. State rules for under-65 beneficiaries and any state-specific windows can change, so confirm them with the Illinois Department of Insurance or the Wisconsin Office of the Commissioner of Insurance before relying on them. If you want help sorting out which rules apply to you, our team can walk through it with you.
Common mistakes that cost people their window
- Waiting for the notice to arrive. The 63 days run from when coverage ends. If your employer or plan told you the end date, start then.
- Assuming dropping a plan creates a right. Voluntarily leaving an Advantage plan after your first year generally does not.
- Skipping Part B. Medigap requires Part B, and your open enrollment depends on it. Avoiding a penalty is a separate issue; see our guide to the late enrollment penalty.
- Throwing away paperwork. Proof of the qualifying event is what turns your request into a right.
- Comparing only premiums. A low introductory price can rise later. Ask how the insurer sets future premiums before choosing.
How Almond Insurance can help
We are a Medicare agency in Rockford, Illinois, serving Northern Illinois and Southern Wisconsin. If your Advantage plan is ending, you are leaving an employer plan, or you are approaching your Medigap open enrollment, we can check the dates with you and lay out your choices in plain language. You do not pay us for the advice. Carriers compensate us when a client enrolls in a plan.
We can walk you through Medicare Supplement and Medigap options, compare them through our plan comparison service, and help with the application through enrollment support. If you are brand new to Medicare, start with our new-to-Medicare guidance.
FAQ
Are all Medigap plans guaranteed issue?
No. Medigap is guaranteed issue only during specific windows, such as your six-month open enrollment period or after a qualifying loss of coverage. Outside those windows, insurers in most states can use medical underwriting and deny you.
How long do I have to apply after I lose coverage?
In most federal guaranteed issue situations, you must apply no more than 63 days after your previous coverage ends. You can usually apply earlier and ask for the policy to start the day the old coverage ends, which avoids a gap.
Can I switch from Medicare Advantage to Medigap whenever I want?
Not with a guaranteed right. You generally need a qualifying event, such as your plan leaving Medicare or your moving out of its area, or a trial right within your first year. Otherwise you may face underwriting.
Which states have guaranteed issue for everyone?
Connecticut, Massachusetts, Maine and New York require continuous or annual guaranteed issue for all beneficiaries 65 and older. Several other states have narrower windows, so check your own state’s rules.
Can an insurer deny me a Medigap policy if I have a pre-existing condition?
Not if you are using a valid guaranteed issue right. Without one, in most states the insurer can decline you or charge more for conditions such as cancer or diabetes with complications.
Sources
- Guaranteed issue rights, Medicare.gov
- Choosing a Medigap Policy, Medicare.gov
- Choosing a Medigap Policy, large print, Medicare.gov
- Key Facts About Medigap Enrollment and Premiums, KFF
- Medigap May Be Elusive for Medicare Beneficiaries with Pre-Existing Conditions, KFF
- Medigap Guaranteed Issue Requirements: An Overview of Federal and State Rules, KFF
- Implementation Guidance for MACRA Revisions to Medigap, NAIC