Guaranteed Issue Rights for Medi-Gap
when you enroll beyond age 65 for Part B as you had Qualifying Employer Coverage
Termination of Employment or Retirement Plan
You have the right to purchase a Medigap policy for 6 months if your, your spouse’s or a family member’s current employment or retirement plan coverage terminates, or you lose your eligibility due to divorce or death of a spouse or family member. The 6-month period to apply for a Medigap policy starts on the date you receive notice that your health benefits will end. If you do not receive advance notice, the 6-month period starts the date the benefits end or the date of your first denied claim. This protection of California law applies whether your group health benefits were primary or secondary to Medicare.
Loss of COBRA
You are also entitled to this protection when you become eligible for COBRA (Our webpage on COBRA) or have used up all your COBRA benefits. It does not apply if you stop paying COBRA premiums before you use all your benefits. COBRA benefits are always secondary to Medicare benefits unless you have ESRD and are in a 30-month coordination period. For more information on COBRA, see Medicare & Other Health Insurance. CA HealthCare Advocates *
COBRA and Medicare are VERY VERY confusing. Double check with us on your specific situation!!!
Guaranteed Acceptance Guide
Blue Shield CALIFORNIA
Blue Cross CA
This is just a summary of the most common ways you can get a Medi Gap plan without having to answer health questions.
- Enrolled in Medicare and are age 65 or older; or New to Medicare, are age 64 or younger, and do not have end-stage renal disease
- You enrolled with A Medicare Advantage Plan and the plan is being terminated;
- terminated from any employer-sponsored health plan,
- moved outside the plan’s service area.
- disenrolled from the plan or program within twelve (12) months of the effective date of that enrollment.
- You terminated enrollment in a Medicare Supplement plan and subsequently enrolled, for the first time, in any of the following:
• A Medicare Advantage Plan; - MAPD Trial Privileges #02110 Medi-Gap Guide
- The company substantially violated a material provision of the contract; or
- The company or its agent materially misrepresented a provision of the plan in marketing the contract to you.
- You enrolled in a Blue Shield Medicare Advantage Plan, and Blue Shield either:
Reduced any of its benefits;
Increased the amount of cost-sharing or premium; - You are no longer eligible for Medi-Cal benefits.
- Birthday Rule
Get more detail at:
CA Health Care Advocates
Federal Choosing a Medi Gap Policy #02110
Guaranteed Acceptance Guide Blue Shield
Scroll down for our cut & paste of the ACTUAL CA Law
(e)
(1) An individual enrolled in Medicare Part B is entitled to open enrollment described in this section for six months following:
(A) Receipt of a notice of termination or, if no notice is received, the effective date of termination from any employer-sponsored health plan including an employer-sponsored retiree health plan.
(B) Receipt of a notice of loss of eligibility due to the divorce or death of a spouse or, if no notice is received, the effective date of loss of eligibility due to the divorce or death of a spouse, from any employer-sponsored health plan including an employer-sponsored retiree health plan.
(C) Termination of health care services for a military retiree or the retiree’s Medicare eligible spouse or dependent as a result of a military base closure or loss of access to health care services because the base no longer offers services or because the individual relocates.
(2) For purposes of this subdivision, “employer-sponsored retiree health plan” includes any coverage for medical expenses, including, but not limited to, coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and the California Continuation Benefits Replacement Act (Cal-COBRA), that is directly or indirectly sponsored or established by an employer for employees or retirees, their spouses, dependents, or other included insureds.
Be careful and double check – COBRA might not get you out of the Part B Late Enrollment Penalty!
What Plan G pays in addition to Medicare Parts A & B
Check our Carrier Pages for the latest Info
Anthem Blue Cross
Blue Shield – Medi-Gap
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Video Introduction to Medi Gap
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Official Medicare Guide to choosing a Medi Gap Policy # 02110
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Please note the rules for Medi Gap and Medicare Advantage are and or can be different! Be sure to double check
Simple explanation from my wholesaler on the rule for MAPD and Part D Rx
There is an SEP – Special Enrollment Period that is always in place for loss of an employer group plan.
It allows you to get signed up on a plan for up to 63 days after the plan is terminated. So it isn’t something you can wait around a long time on but you do have 63 days from the end of the group plan to utilize that s e p for your client.
If it happens to be past that time frame then you need to utilize AEP to get them on board right away for a 1-1 effective date
https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf#page=8
Please note the rules for Medi Gap and Medicare Advantage are and or can be different! Be sure to double check
Simple explanation from my wholesaler on the rule for MAPD and Part D Rx
There is an SEP – Special Enrollment Period that is always in place for loss of an employer group plan.
It allows you to get signed up on a plan for up to 63 days after the plan is terminated. So it isn’t something you can wait around a long time on but you do have 63 days from the end of the group plan to utilize that s e p for your client.
If it happens to be past that time frame then you need to utilize AEP to get them on board right away for a 1-1 effective date
https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf#page=8
Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?
The waiver of Pre X would be the same. Situation # 4 above says the enrollment period is 6 months. It gets QUITE confusing with different rules for different enrollments… Part B Outpatient, Part D Rx, Medicare Advantage, etc. One has to check each option with a fine tooth comb!
See links above to enroll online with Blue Cross and Blue Shield.
Here’s our scheduler to set a zoom meeting with screen sharing. https://steveshorr.com/intro/set-a-meeting/
Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?
The waiver of Pre X would be the same. Situation # 4 above says the enrollment period is 6 months. It gets QUITE confusing with different rules for different enrollments… Part B Outpatient, Part D Rx, Medicare Advantage, etc. One has to check each option with a fine tooth comb!
See links above to enroll online with Blue Cross and Blue Shield.
Here’s our scheduler to set a zoom meeting with screen sharing. https://steveshorr.com/intro/set-a-meeting/
I already have Medicare A and want part B. I am covered by a federal employee health plan (FEHB). Medicare (SSA) says I need to have a form filled out by my company president to verify employment- my W2 and tax form indicating coverage is not enough. Online it says my Medicare part B won’t start until July.
We will answer that question on our page about if you have employer coverage – do you have to enroll in parts A, B & D?
This is utterly confusing. It says six month period of eligibility but that you must apply within 63 days of termination? Makes no sense to me.
Right. Please send a copy of your termination notice and if at all possible, all documents from your Employer’s Health Plan. Don’t hold back. We need to see if your under situation 4 or 11.
Did the plan supplement Medicare or not?
If one gets terminated from their spouses retiree benefits plan when the spouse passes away is there a guaranteed enrollment period into Medi Gap and how does it work?
Yes. See situation # 4 above.
If you cancel your Part B, then you to reinstate Part B later will you have guaranteed issue rights for Medi Gap?
Good POINT!
Excerpt from Medicare Medi Gap Guide # 02110 * Medicare.Gov *
From prior conversations and emails, you’ve stated that you have an application pending for Part B, but have not been enrolled. I’d check and see if you can get the application cancelled, as if you never asked to be enrolled in Part B.
Either you or I can write to HICAP – CA Advocates and see what light they can put on the subject.
This may be a question to learn when you got Part B and if you can get guaranteed issue at a later date…