Medigap Guaranteed Issue Rights: When a Plan Must Sell You a Policy

Most of the time, a Medigap firm can ask about your health before it sells you a policy. It can charge more. It can say no. A guaranteed issue right turns that off for a short time. When you have this right, the firm must sell you a policy. It must cover health problems you already have. It cannot charge you more because of your health. This guide lists the cases that create the right, the plans it covers, and the clock that runs with it. Our Medicare Supplement section holds more guides on these policies.

What the right does

A Medigap policy helps pay the costs Original Medicare leaves. You pay the Part B premium of $202.90 per month in 2026 (Ledger A1). You pay the Part B deductible of $283 for the year in 2026 (Ledger A2). You pay a share of most bills after that. A Medigap policy pays toward those costs. It does not cover a service on its own.

When you apply with a guaranteed issue right, three things change. First, the firm must sell to you if you pick a plan on the list for your case. Second, the firm must cover health problems you had before the policy starts. Third, the firm cannot set your price based on your health.

When you apply with no right, none of that holds. The firm can ask health questions. It can set a higher price. It can refuse the sale. The right is the line between those two paths.

The cases that create the right

Federal law names the cases. Each case starts with a loss or a change that was not your choice to lose cover.

Each case has proof rules. The firm can ask for the letter that shows your old cover ended. Keep that letter. Keep the date on it. The date starts your clock.

Our guide on Medigap for people under 65 with a disability covers a group federal law treats in a distinct way. Federal law does not give that group the same buying rights. Some states add rights of their own.

• Your Medicare Advantage plan leaves Medicare. The plan may end its deal with Medicare, or Medicare may end it.
• Your Medicare Advantage plan stops serving your area. The plan pulls out of your county or cuts its service area, and you must leave.
• You move out of your plan service area. The plan does not serve your new home, so your cover cannot move with you.
• Your employer or union group cover that pays after Medicare ends. This case has fine terms. The type of cover and the way it ends both matter.
• You have a Medicare SELECT policy and you move out of its service area. A SELECT policy ties you to a set network in one area.
• Your Medigap firm goes bankrupt. Your policy ends through no fault of your own, or the firm breaks the rules and your cover ends.
• A plan or firm broke the rules or misled you. You left the plan or dropped the policy because of what the firm did.

The two trial rights

Trial rights are a part of this same system. They cover a choice, not a loss. You chose to try a Medicare Advantage plan. The law gives you one year to change your mind and still buy Medigap with no health questions.

The first trial right fits a person who joined a Medicare Advantage plan when they first became eligible for Medicare at 65. Leave in the first 12 months, and you can buy any Medigap policy sold in your state.

The second trial right fits a person who dropped a Medigap policy to try a Medicare Advantage plan for the first time. Leave in the first 12 months, and you can buy back your old policy if the same firm still sells it. If the firm no longer sells it, you can buy a plan from the set list in the next section.

Our guide on the Medigap open enrollment window covers the first and best window of all. That six-month window starts when you are 65 or older and first have Part B. In it, you can buy any policy sold in your state. Most people reading this guide are past that window. That is why the rights in this guide matter.

The plans the right covers

Most rights cover a set list. The list is Plan A, B, D, G, K, or L, when the plan is sold in your state. Plan C or Plan F joins the list if you were eligible for Medicare before 2020. Plan N is not on the federal list. Plan M is not on the list.

One case breaks that rule. The first trial right, for a person who joined a plan at first eligibility at 65, covers any Medigap policy sold in the state. That is a wider choice than the set list.

Plans with the same letter have the same benefits no matter which firm sells them. The price is what changes from firm to firm. With a right in hand, you can shop the list by price. The firm cannot raise your price for health reasons. It can still charge its set price for the plan.

This guide states no premium for any plan. Medicare does not set Medigap prices. Firms set them. A price quote must come from the firm itself.

The clock on the right

The right does not last. In most cases, you can apply as early as 60 days before your old cover ends. You must apply no later than 63 days after your old cover ends.

That back end is strict. Day 64 is too late. If you miss it, the firm can treat you as a new buyer with no right. It can ask health questions at that point.

Some cases set the clock from a distinct date. If you learned your group cover ended from a claim denial, the clock can run from that date or the notice date. Read the letter that came with your case. It names the dates that count for you.

Write the end date on a calendar the day you get the letter. Then apply well before it. A firm may need time to check your proof. Time spent on proof still counts on your clock.

Who pays for what

• Original Medicare pays its share of your care first. Part B costs you the premium of $202.90 per month in 2026 (Ledger A1) and the deductible of $283 for the year in 2026 (Ledger A2), then a share of most bills.
• A Medigap policy pays toward the costs Original Medicare leaves. It pays only when Original Medicare pays first. It does not cover a service on its own.
• You pay the Medigap premium the firm sets. With a guaranteed issue right, the firm cannot raise that price because of your health.
• A Medicare Advantage plan pays for your care while you are in it. That role ends when you leave the plan.
• Medicaid can help with Medicare costs for people who qualify through their state. The state Medicaid office takes the application.
• Private pay covers care that no plan covers. Check cover before you book care.

Sample situation

Ana is 74. She has been in a Medicare Advantage plan for four years. In the fall, the plan sends a letter. The plan will stop serving her county next year. Ana wants Original Medicare with a Medigap policy. Her plan leaving the area gives her a guaranteed issue right. She picks Plan G from the set list. The firm must sell it to her. It cannot ask health questions. It cannot charge her more for the heart problem she had two years ago. Ana applies in the fall, well inside her clock. Her old cover ends on the last day of the year. Her Medigap policy starts the next day. She pays the Part B premium of $202.90 per month in 2026 (Ledger A1). She works toward the Part B deductible of $283 for the year (Ledger A2). Her Medigap policy helps with the costs Original Medicare leaves. Ana keeps the plan letter in a file. It is her proof of the right if a question comes up later.

Steps to use a right

A guaranteed issue right is a short bridge. It opens when cover ends through no fault of your own, or when a first-year trial goes wrong. Know your case, know your end date, and cross the bridge while it is open.

• Read the letter that ended your old cover. Name the case that fits you.
• Write down your end date. Count 63 days from the end of your old cover.
• Pick a plan from the list your case covers.
• Apply early. Send the proof letter with your application.
• Ask your state insurance office if your state adds rights of its own.
• Keep copies of each form and letter.

Sources

• https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights
• https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/buying-a-medigap-policy