Medigap Guaranteed Issue Rights and When They Apply

Medigap guaranteed issue rights are legal protections that require a Medicare Supplement insurance company to sell you a policy, charge you the same premium a healthy applicant would pay, and skip any waiting period for pre-existing conditions. These rights apply only during specific windows, most often your six-month Medigap Open Enrollment Period or after a qualifying life event such as losing employer coverage or leaving a Medicare Advantage plan within 12 months. Outside those windows, insurers in most states can use medical underwriting, meaning they review your health history and can deny your application or charge more based on past conditions.

This guide covers the qualifying events that trigger Medigap guaranteed issue rights, the 63-day deadline you need to track, which Medigap plans you can choose under guaranteed issue, and how some states offer stronger protections than federal law requires.

Your Medigap Open Enrollment Period: The Broadest Protection

The strongest guaranteed issue protection is your Medigap Open Enrollment Period, a one-time six-month window that starts the month you turn 65 and are enrolled in Medicare Part B. Medicare Part B is the portion of Original Medicare that covers outpatient care, doctor visits, and durable medical equipment. During this window, every insurer selling Medigap policies in your state must offer you any plan it sells, at the same price it charges a healthy applicant of the same age, regardless of your health conditions.

This six-month window is the best time to enroll because it carries the fewest restrictions. Once it closes, insurers in most states can apply full medical underwriting. If you delayed Part B because you had coverage through an active employer or union plan, your Medigap Open Enrollment Period starts when your Part B coverage begins, not when you turned 65. If you're weighing your options as employer coverage ends, our guide on enrolling in Medicare after losing employer coverage walks through the timing.

Qualifying Events That Trigger Guaranteed Issue Rights

Beyond your initial Open Enrollment Period, federal law requires Medigap insurers to grant guaranteed issue rights when specific life events occur. The major qualifying events include:

• You lose employer or union coverage that supplemented Medicare, whether from retirement, job loss, or the plan closing.
• You leave a Medicare Advantage plan within the first 12 months of joining, known as your federal trial right, which lets you return to Original Medicare and enroll in Medigap without underwriting.
• Your Medicare Advantage plan leaves Medicare or stops serving your area.
• You move out of your Medicare Advantage or Medicare SELECT plan's service area and the plan cannot cover you in your new location.
• Your Medigap insurer becomes insolvent or otherwise stops covering you through no fault of your own.
• Your Medigap insurer misled you and a court or regulator finds you were harmed, entitling you to a replacement policy.

If a Medicare Advantage plan leaving your area or changing its network is what triggered your qualifying event, note the date on your notice. That date starts your 63-day clock immediately.

Which Medigap Plans Are Available Under Guaranteed Issue?

Federal law sets a minimum standard: during a guaranteed issue event, insurers must offer you at least Medigap Plan A. For most qualifying events, the available plans expand to include Plans A, B, D, G, K, and L. The exact selection depends on which qualifying event applies, so confirm with your insurer or a SHIP counselor.

If you became eligible for Medicare before January 1, 2020, you may also be able to choose Medicare Supplement Plan F, which covers the widest range of out-of-pocket costs, or Plan C. Beneficiaries who first became eligible on or after January 1, 2020 cannot purchase Plan F or C, even under guaranteed issue, due to a federal law change that took effect that year.

Many people in a guaranteed issue situation choose Plan G, which covers nearly everything Plan F does except the annual Part B deductible. For a side-by-side look at the two most popular options, see our comparison of Medigap Plan G vs. Plan N. State laws can expand these choices further, some states require insurers to offer more plan types than the federal minimum, so check with your state insurance commissioner or a SHIP counselor for local rules.

What Guaranteed Issue Rights Do Not Cover

Guaranteed issue rights are meaningful protections, but they have limits worth understanding.

• They do not freeze your premium forever. Insurers can still raise your Medigap premium over time due to age, inflation, or general rate increases allowed in your state. Guaranteed issue only prevents the insurer from charging you more at enrollment because of your health.
• They do not apply to Medicare Advantage plans. Medicare Advantage, also called Part C, has its own separate enrollment rules. Guaranteed issue rights are specific to Medigap policies. For a full comparison, see our guide to Medicare vs. Medicare Advantage.
• They do not include prescription drug coverage. Medigap plans do not cover prescription drugs, so if you need Part D you'll need to enroll separately.
• They may not cover every plan type in every situation. The specific plans you can access depend on which qualifying event applies. Federal law sets a floor, and your actual choices may be broader depending on your state.

State Protections That Go Beyond Federal Law

Federal law sets the floor, but many states have enacted stronger guaranteed issue protections. A few notable examples:

• Year-round open enrollment: Some states, including New York and Connecticut, require Medigap insurers to accept applicants year-round regardless of health status.
• Birthday rules: Several states, including California, Idaho, Illinois, Louisiana, Missouri, Nevada, Oklahoma, and Oregon, allow you to switch to a Medigap plan with equal or lesser benefits around your birthday each year, without medical underwriting. Rules vary by state.
• Anniversary rules: Some states allow a similar annual switch window tied to your policy anniversary date rather than your birthday.

State rules change over time and this list is not exhaustive. According to Medicare.gov, guaranteed issue rights are the specific circumstances under which insurance companies must sell you a Medigap policy. Your State Health Insurance Assistance Program, known as SHIP, offers free, unbiased counseling and can confirm the exact protections in your state. You can find your local SHIP through Medicare.gov.

To compare all the plan types available in your area, see our guide to comparing senior plan options.