Medicare Supplement Plans – What Are Guaranteed Issue Periods and When Do They Occur?

Medicare Supplement plans have certain “Guaranteed Issue” periods that allow individuals to apply for a plan without denying you coverage, excluding your pre-existing conditions, or charging you more because of any health conditions. These guaranteed issue (GI) rights are Federally-mandated by the Centers for Medicare & Medicaid Services and apply to you all Medicare-enrollees who are in one of these specific situations.

The GI rights generally occur when your current health care coverage is changing in a certain way or you are involuntarily losing your coverage. Specific insurance companies may create their own GI situations, and they do; however, there are seven Federally-prescribed GI situations that all Medicare Supplement insurance companies must follow. If you fall into one of these periods, you should be able to sign up for a Medicare Supplement plan on a Guaranteed Issue basis. These seven situations are:

  1. You have employer or union coverage that pays AFTER Medicare, and that coverage is ending.
  2. You are enrolled in a Medicare Advantage plan, and this plan is leaving the Medicare program, stops servicing your area, OR you are moving out of the plan’s specific service area.
  3. You have a Medicare SELECT policy, and you are moving out of the plan’s service area. You can keep your current policy, but you do have the right, on a GI basis, to switch to a new policy.
  4. Your Medicare Supplement company goes bankrupt, which causes you to lose coverage. OR, you lose Medicare Supplement plan coverage through no fault of your own.
  5. You enrolled in a Medicare Advantage plan or PACE when you were first eligible to enroll, and within a year of joining, you wish to switch back to “original” Medicare (and a Medicare Supplement plan).
  6. You dropped a Medicare Supplement to switch to a Medicare Advantage or Medicare SELECT policy for the first time. You have been in that plan for less than a year and wish to switch back to Medigap.
  7. You decide to drop a Medigap policy or leave a Medicare Advantage plan because the company hasn’t followed the rules or misled you in some way.

Individual states also have the authority to create additional GI situations, and some have done so. Also, some of the specific GI situations have particular requirements for the plans that you can go into. For example, you may be eligible for a GI into a Medicare Supplement plan; however, it may have to be one of certain plans.

It is advantageous for you to be aware of these guaranteed issue situations if you are on Medicare. If you fall into one of them and elect not to sign up for a plan while that GI period is in effect, you will, most likely, have to qualify medically for a Medicare Supplement if you do decide to sign up at a later time.

What You Need To Know About Medicare Supplement Plan J

Should you keep your Medicare supplement Plan J or compare other plans?

Oftentimes referred to as Medigap Supplement Plan J, Medicare Supplement Plan J covers certain costs that are not covered in basic Medicare benefits coverage. Unfortunately, Plan J is no longer available (effective May 31, 2010). However, the plan will remain in effect for those individuals who were enrolled in it by the 1st of June, 2010. Additionally, there is a separate $250 annual deductible.

What Does Plan J Cover?

As with any Medicare Advantage or Medigap Insurance plans, Plan J covered certain gaps in Medicare Part A and B coverages. This includes:

• at-home recovery

• care provided by skilled nursing facilities

• emergency care when traveling overseas

• excess Part B charges/expenses

• Medicare co-insurance (Part B)

• Part A and B deductibles

• up to $120 of preventative care that Medicare does not cover

What The Plan Does Not Cover

Unfortunately, there are certain health care issues that are not covered by Plan J (according to the Centers for Medicare and Medicaid Services) including the following:

• dental care

• eyeglasses

• hearing aids

• long-term nursing home care

• private-duty nursing

• vision care

The bottom line is that the elimination of Plan J resulted from the need to modernize the entire Medicare Insurance infrastructure.

Elimination By Default

It has oftentimes been said that Plan J was simply eliminated by default because there were two benefits covered that were similar to the ones covered by Plan F. Plan F has oftentimes been considered the most comprehensive of all the MA/Medigap plans. The two specific benefits that set Plan J apart from Plan F are at-home recovery and preventative care. The Centers for Medicare & Medicaid Services have eliminated these two coverages due to a lack of use. Therefore, Plan J was eliminated because of this duplication.

Additional Considerations

It is important to note that existing Plan J policy holders who are not affected by the above will be subject to what is referred to as a “closed block of business”, meaning that no new policies will be offered after the June 1st eligibility date. There is considerable speculation that the rates for Plan J coverage are going to increase as a result of the above. Although this does make sense to some, the impact on current policy holders remains to be seen. It is a good idea for anyone who has Plan J to evaluate the current Medigap Plans available and compare the benefits and premiums to what they are currently paying. They may be surprised to learn they can save money and get comparable benefits to Plan J.

How to Catch a Medicare Supplement Agent: The Good, the Bad, and the Ugly

As a Medicare Supplement agent myself, I understand the stigma attached to insurance agents. Fortunately, I do not fit the stereotypical, smooth-talking, car salesman prototype, but I know many agents who do. Since Open Enrollment is almost over, and many people are deciding to switch from Medicare Advantage to Medicare Supplement, I thought I might add my two-cents regarding choosing the perfect agent, just in case any consumers are interested in what distinguishes the good from the bad, and the bad from the ugly.

One thing that divides the multitudes is who they work for and how they get their leads. Although cold calling became illegal, many Medicare Supplement agents still find people not located on the “Do Not Call” lists, and spend their days pestering these unknowingly vulnerable consumers. If an agent calls you, and you have no idea where they got your number, HANG UP. This agent is in direct violation of a federal law, and there is no knowing what else this bottom feeder might be up to.

Independent agents, meaning agents who do not work for anyone, aside from being contracted with carriers, are usually the culprits behind cold-calling. However, this does not mean there aren’t reliable independent agents out there, in fact, I am one of them! Surprisingly, independent agents can be some of the best in the business, as long as they do not resort to cold calling or pestering. Why? Well, firstly, most agents work at big call centers or for the carriers themselves. If you work with a major call center (20+ agents), you are just one client out of thousands. As for agents who work for only one carrier, they are unable to give you more than one quote, and everyone knows shopping around is a tenant of Consumerism 101. Never speak to an agent that only works for one carrier, because I can guarantee that you are hearing a biased sale’s pitch– something every consumer, in every market should be weary of. Independent agents have neither of these problems. They are usually contracted with several competitive carriers for their area, and maintain a manageable client base– making them one of the best ways to get the most competitive price on a Medicare Supplement policy. Disclaimer: There are some smaller call centers that refrain from growing too large, and these are good places to shop around, as well. In general, stay clear from anyone who is not helping you shop, i.e. someone who does not understand that you want to hear about more than just one option available.

Agents who only offer one plan type, specifically Plan F cannot be trusted. “But I thought Plan F was the best plan out there?!” And you’re correct, in terms of coverage, Plan F is the most comprehensive. However, in terms of commission profits, Plan F is the most lucrative plan an agent can sell. If you are speaking with an agent who doesn’t want to discuss any other plans with you, I can guarantee that this agent is most likely 1. very inexperienced or 2. very greedy, and no one likes a greedy insurance agent. For example, I can save someone about $30-$50/month by purchasing a Plan G instead of Plan F, the difference? Plan G does not cover the Medicare Part B deductible of $147. You do the math. Some agents would rather make a bigger commission than do what’s right for the consumer.

Customer service is something that many insurance agents don’t understand. When a Medicare enrollee calls to discuss benefits, but then also has other questions or concerns, some agents will do the bare minimum for that consumer. A good agent will take the time to explain something to you, as well as making sure you fully understand every part of the plan’s benefits, the application process, payment, and so forth. A good agent will also keep you as their client, checking in every so often to make sure you are still happy with your policy.

The last quality I will discuss is humility, along with competency– two of the most important assets an agent can possess. There is not a single Medicare Supplement agent that knows everything about Medicare, the carriers, health conditions, etc. There are always questions. That’s why it’s good to have an agent who will tell you “Let me make sure this is accurate,” or will admit “I don’t know.” I rather have an agent ask the right person than attempt to be the smartest cookie in the agent jar.

Sometimes it is easy to go with the first agent who calls, but next time utilize the power of the consumer when shopping for a Medicare Supplement policy; I promise, you won’t regret the decision to be picky.