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!!!
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
On some pages you can Scroll down for our cut & paste of the ACTUAL CA Law
(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!
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- Can you postpone Part A enrollment if you are covered under a Employer Group Plan?
- Early Retirement – What Health Insurance?
- Medicare – Dual Coverage – Subrogation
- Part B Late Enrollment Penalty
- Retiring? Medicare or Employer Group?
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