Open Enrollment Guidelines:

When enrolling in a Medicare Supplement policy, there are two routes a person can take.

1. Either the enrollment is guaranteed based on one of the situations discussed on this page below.
2. Or the applicant must answer all medical history questions along with current and past doctors and prescriptions taken.  The company will then review the questions answered and base their approval or decline based on your health status.

The Medicare Supplement industry has certain rules and regulations pertaining to “guarantee-issue” situations and “open-enrollment.”  Below are the rules that apply.

Below are many of the “Open-Enrollment” Rules:

• The Initial Enrollment Period: You have a 7 month window of opportunity, starting 3 months prior to your Medicare Part B coverage month start date, the month of the start date and ending 3 months after the month of your birthday or Part B start date.  During this time you can choose any Medicare Supplement plan or company providing coverage in your resident state.

• Special Enrollment for Part B: Part B enrollment may be delayed if you are over age 65 and  have group health insurance as a result of your current employment or your spouse’s current employee health plan.  Or, you are disabled and continue your employers group health insurance plan.  In any of these instances, you will qualify for a special 63 day enrollment period beginning the month after the termination of your group health insurance.  If you do not enroll by the end of this grace period, you will have to answer the health questions on the application and be approved medically.

• If you loose your Medicare Advantage plan coverage due to one of these reasons:  A) Medicare Health Plan terminates or stops providing care in your area.  B) Beneficiary moves outside the Medicare Health Plan service area.  C) Beneficiary leaves the plan because it failed to meet it’s required obligations to them.  D) The beneficiary must enroll in a Medicare Supplement plan within 63 days of losing coverage.

• (Trial Right) You enrolled in a Medicare Advantage plan for the first time, either when you first became eligible for Medicare Part B or after having a Medicare Supplement plan.  Then within the first year of joining the Medicare Advantage plan, you wish to cancel or dis-enroll and switch to Original Medicare and a Medicare Supplement plan company and plan of your choice.

• Birthday Rule (California Only) You are entitled to switch companies to a plan with equal or less benefits for 60 days beginning on your birthday.  You must currently have a Medicare Supplement plan, and provide proof of prior coverage.

• Military – Termination of health care for military retiree or spouse or dependents due to military base closure, base no longer offers services, or you relocated.  If you are a Medicare eligible military retiree or dependent and at least 65 you are entitled to a 6-month guaranteed issue period beginning the date you lost health care services at the military base.  You must provide proof of prior coverage.

• Your Medicare Advantage plan, reduces benefits, increases the cost sharing amount, or discontinues a provider for other than good cause.  If any of these events occur you are entitled to a guaranteed issue period of 63 days.  You must provide proof of prior coverage.

• Disabled and receiving Medicare benefits prior to your 65th Birthday.  Once your Medicare Part B coverage is approved you will be offered a 6-month guaranteed issue period.  You will then be offered an additional 6 month period beginning with the date of your 65th birthday.

• Termination of coverage under a group-sponsored health plan: If you are receiving health care coverage through your group employer and you decide to terminate the group plan, or the benefits of the group plan are reduced, you are entitled to a six-month Guaranteed Issue period beginning on the date of termination or benefit reduction. With your application, you must provide proof of disenrollment or benefit reduction.

• If you had Medi-Cal or Medicaid benefits and have lost eligibility for those benefits, you are guaranteed acceptance into a Medicare Supplement plan, provided that you apply within six months of losing eligibility that you received from Medi-Cal or Medicaid. With your application, you must provide a copy of the notice of loss of eligibility that you received from Medi-Cal or Medicaid.

There may be other guaranteed enrollment opportunities in your state, so please call so we can discuss your current situation.

Questions?

John Conner
916-682-1117
[email protected]