Eligibility for Open Enrollment and Guaranteed Issue Period
1. ELIGIBILITY FOR OPEN ENROLLMENT:
- is at least 64 1/2 years of age and within six months before or after his/her effective date for Medicare Part B, or
- is covered under Medicare Part B prior to age 65 (eligible for a 6 months open enrollment period upon reaching age 65)
Note: Coverage cannot be effective until your Medicare coverage is effective.
Open Enrollment Example: If you are turning 65 and will enroll in Medicare Part B in the next six months or if you are over 65 and enrolled in Medicare Part B within the last six months, you are not required to answer health questions.
2. ELIGIBILITY FOR GUARANTEED ISSUE:
- is in Original Medicare, has an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays, and that coverage is ending
- is in Original Medicare, has a Medicare select policy, and moves out of the Select plan's service area
- loses coverage due to their Medicare insurance company's insolvency or at no fault of the applicant
- the applicant leaves their Medicare supplement plan because the company has not followed rules, or has misled the applicant
Guaranteed Issue Example: If you are coming off your employer group coverage or COBRA health insurance plan, or your Medicare Advantage Plan stops providing coverage in your area, you are NOT required to answer health questions.
3. APPLICANT ENROLLED IN A MEDICARE ADVANTAGE PLAN (MA), and:
1. the plan is leaving the Medicare program or stops service in the applicant's area, or the applicant moves out of the plan's service area (applicant must switch back to Original Medicare)
2. the applicant leaves the plan because the company has not followed rules, or has misled the applicant
Advantage plan when first eligible for Medicare Part A at age 65
3. the applicant decides to switch back to Original Medicare within the first year of joining a Medicare
4. the plan is leaving the Medicare program or stops service in the applicant's area or the applicant decided to switch back to Original Medicare within the first year of joining a MA plan when first eligible for Medicare Part A at age 65
4. SWITCHING MEDICARE SUPPLEMENT PLANS:
1. can switch their current Medicare supplement coverage anytime during the year to a different Medicare Supplement Plan to save premium cost
2. is required to answer health questions with most companies to switch plans