New Illinois Guaranteed Issue Medigap Rules

Outside of certain enrollment times, Medigap plans are not guaranteed issue plans. This means that a carrier can reject your application for enrollment based on your medical condition and history. If they choose to approve your application, they can also charge you higher rates if you are deemed to be a “risky” member. Ahead we will look at some Illinois Medigap Rules.

However, the federal law does provide protections for Medicare beneficiaries in some instances. While there are some laws that apply to the entire United States, others are state-specific.

In Illinois, there are seven instances when you will have guaranteed issuance of a Medigap plan. It’s important to understand the differences in these plans as we read, so reference this chart when necessary.

1. You currently have a Medicare Advantage plan, and the plan is being discontinued (all together or in your area), or you move from the plan’s service area.

In this case, you can purchase Medigap plans A, B, C, F, FHD (high deductible plan F), K, or L if you were eligible for Medicare prior to January 1, 2020, or Medigap plans A, B, D, G, GHD, K, or L if you were eligible for Medicare after January 1, 2020.

You may apply for one of these Medigap plans 60 days prior to the date your current coverage ends or up to 63 days after it ends. Your Medigap policy will not begin until your Medicare Advantage policy ends.

Medicare Advantage Plans

2. You currently have Original Medicare and another group policy (like from an employer) that pays as secondary, and that group policy no longer provides benefits. The guaranteed issue does not apply to those who voluntarily disenroll from the secondary plan.

In this case, you can purchase Medigap plans A, B, C, F, FHD (high deductible plan F), K, or L if you were eligible for Medicare prior to January 1, 2020, or Medigap plans A, B, D, G, GHD, K, or L if you were eligible for Medicare after January 1, 2020.

You must apply for one of these plans no later than 63 days after either your current coverage ends, you get a notice informing you that coverage is ending, or from the date on the claim denial (if this is how you find out that your current coverage ended.)

3. You currently have Original Medicare and Medicare SELECT, and you move out of the SELECT service area.

In this case, you can purchase Medigap plans A, B, C, F, FHD (high deductible plan F), K, or L if you were eligible for Medicare prior to January 1, 2020, or Medigap plans A, B, D, G, GHD, K, or L if you were eligible for Medicare after January 1, 2020.

You may apply for a Medigap plan 60 days prior to your SELECT coverage end date and no later than 63 days after the coverage end date.

4. Trial Right: You got a Medicare Advantage plan when you were first eligible and then decided you wanted to switch back to Original Medicare within the first year of being on the plan.

In this case, you can apply for and Medigap policy sold in Illinois, excluding Plan F and FHD, if you became eligible for Medicare after January 1, 2020.

You may apply 60 days prior to your current coverage end date, up to 63 days after the current coverage end date.

Eligibility in Illinois

5. Trial Right: You disenrolled from a Medigap plan to join Medicare Advantage or SELECT (first-time enrollees only), and you decide you want to switch back to Original Medicare within the first year of being on the plan.

In this case, you must enroll in the Medigap plan that you had prior to the Medicare Advantage or SELECT plan if the same carrier still sells it. If it does not, you can purchase Medigap plans A, B, C, F, FHD (high deductible plan F), K, or L if you were eligible for Medicare prior to January 1, 2020, or Medigap plans A, B, D, G, GHD, K, or L if you were eligible for Medicare after January 1, 2020.

You may apply 60 days prior to your current coverage end date, up to 63 days after the current coverage end date.

6. Your current Medigap insurance carrier goes bankrupt, or you lose coverage through no fault of your own.

In this case, you can purchase Medigap plans A, B, C, F, FHD (high deductible plan F), K, or L if you were eligible for Medicare prior to January 1, 2020, or Medigap plans A, B, D, G, GHD, K, or L if you were eligible for Medicare after January 1, 2020.

You must enroll in a new plan no later than 63 days after your coverage ends.

7. You leave your current Medigap or Medicare Advantage plan because the carrier has not followed its rules or has misled you.

In this case, you can purchase Medigap plans A, B, C, F, FHD (high deductible plan F), K, or L if you were eligible for Medicare prior to January 1, 2020, or Medigap plans A, B, D, G, GHD, K, or L if you were eligible for Medicare after January 1, 2020.

You must enroll in a new plan no later than 63 days after your coverage ends.

To find out if you qualify for a guaranteed issue plan, give The Medicare Gurus a call. We can discuss your situation and find out if you qualify for a guaranteed issue Medigap plan in Illinois.