If you can’t qualify for a Medicare Supplement Plan because of health issues, you’ll have to get it through guaranteed issue (GI).
A Guaranteed Issue situation can happen in several instances, and I’ll list some relevant ones below:
- You have MAPD or SELECT plan and you left the coverage area and want to change to a Medigap Plan. This generally must be done within about two months of the notification of the move.
- Your plan has decided not to continue servicing your area
- You lose an employer plan
- You have a SELECT policy (kind of a hybrid between Medigap and MAPD in my opinion)
- You had a Medigap plan and left the plan (within a year) to try out an MAPD or SELECT plan, and within that year changed your mind
- The company lied to you or didn’t follow the rules
- You live in a state (such as CA) that has additional rules and one of those is activated (CA allows you to change from MAPD to Medigap if there is an certain increase in copays)
If you have a second home or financial means to get a second home, you might want to consider moving to another county or state that is outside the coverage area of your MAPD. This will cause her to lose coverage and then you could apply for a plan using GI.
However, there are some risks to this which I will outline below:
- You cannot “pretend” to move. This is insurance fraud. You would need to actually move out of the MAPD’s service area and establish residency to legally obtain the GI reason. You could tell the insurance company in advance of your intent to move so that you could get the “letter of termination” sooner, however.
- You could find out the service area by calling the insurance company and asking what your coverage area actually is. Some plans cover neighboring counties but not the other. Most plans do not cover outside a state’s boundaries. For example, a plan that covers certain counties in South Carolina will likely not cover counties in Georgia.
- Once you have obtained residency and obtained the insurance, there is no rule prohibiting you from moving again. However, your insurance rates in the new residence could go up. (Let’s say that rates in SC were for example, higher than insurance rates in GA—(BTW I have no idea what the rates are in GA, I’m speaking in hypotheticals here), then the insurance company could raise your rates. Or the insurance could be higher in the state you moved in or out of.
- Most insurance agents will not help you make a GI move. This is because we generally do not get paid by the insurance companies to assist you with this type of move, yet we still take on liability and overhead if we assist you with a GI move.
- During the transition from MAPD to Medigap she could have a period of time where she didn’t have either. This is because the MAPD plan must terminate first, before you can get the Medigap. And the Medigap isn’t going to give coverage without the Letter of Termination. It could take a month to get that letter. She would continue to have Medicare once she lost the MAPD plan, but as you probably already know, the out of pocket costs during that month could be high.