The Senior Citizens League
Medicare Recipients Can Be Denied Supplemental Medigap Coverage Due to
Pre-Existing Conditions


“Guaranteed Issue” Rules for Medigap Need to Be Strengthened, Says The Senior Citizens League

(Washington, DC)  Older adults who are considering dropping their Medicare Advantage plan to return to “traditional” Medicare and a
supplemental Medigap policy are urged to get counseling before canceling their health plan, warns The Senior Citizens League.  “There
are no federal pre-existing condition protections for retirees who want to leave their Medicare Advantage plan, which allows individuals to
buy a Medigap policy.  This is also the case for people who already have a Medigap policy, and who just want to switch to a different one,”
says Mary Johnson, a Medicare policy analyst for The Senior Citizens League.  “Older adults can be denied coverage by Medigap insurers
due to pre-existing medical conditions, because of the lack of ‘guaranteed issue’ protections,” Johnson says.

Depending on the plans selected, Medigap policies cover some or all of Medicare-covered out-of-pocket costs.  These include
deductibles, and co-insurance.  Johnson notes that the guaranteed issue protections that Medicare recipients enjoy when they enroll in
Medicare Advantage and free - standing Part D plans — which allow plan enrollees to shop and switch plans annually— don’t apply to
Medigap policies.

When guaranteed issue rights apply, the insurer must sell consumers a policy that covers all pre-existing conditions, and cannot charge
more for the policy because of past or current health problems.  Older adults who want to purchase a Medigap policy, however, only have
a one-time, 6-month initial enrollment period that begins when they first enroll in Medicare Part B.  “While there are a few exceptions for
special circumstances, retirees who give up their Medigap supplement or retirees who want to try Medigap after being enrolled in
Medicare Advantage for more than 12 months have missed the opportunity to get a supplement in the future,” Johnson says.

Only four states require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in the original
Medicare (California, Connecticut, Maine, and New York).  There are a few special exceptions, such as when a Medicare Advantage plan
is leaving Medicare or moving out of the enrollee’s coverage area.  There’s also an exception if an enrollee first joins a Medicare
Advantage Plan when first eligible at 65 and then decides to switch to traditional Medicare within the first year of joining. The Medicare
website,www.Medicare.gov, outlines the special circumstances under which beneficiaries may qualify for Medigap guaranteed issue
rules.

The Senior Citizens League recommends that people shopping for a new health plan get free unbiased one-on-one assistance from a
State Health Insurance Program (SHIP) counselor.  The programs vary in name depending on location, but many operate out of Agencies
on Aging, local senior centers, and social services departments.

The Senior Citizens League believes guaranteed issue rules for all private Medicare insurance plans and supplements should be made
consistent, to allow purchasers of Medigap supplements to compare policies and switch to better or lower-costing ones, in the same way
that beneficiaries already can for Medicare Advantage and Part D plans.
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With 1.2 million supporters, The Senior Citizens League is one of the nation’s largest nonpartisan seniors groups. Its mission is to
promote and assist members and supporters, to educate and alert senior citizens about their rights and freedoms as U.S. Citizens, and to
protect and defend the benefits senior citizens have earned and paid for. The Senior Citizens League is a proud affiliate of The Retired
Enlisted Association.  Visit www.SeniorsLeague.org for more information.