Guaranteed Issue Right

Definition. A protection under federal and state law that requires Medigap insurers to sell you a policy, without medical underwriting, after specific events such as losing employer or union coverage or your Medicare Advantage plan leaving your area.

What it means

Common events that give you a guaranteed issue right:

• Your employer or union group coverage that pays after Medicare ends.
• Your Medicare Advantage plan leaves your area or stops serving it, or you move out of its service area.
• You joined Medicare Advantage (or PACE) when first eligible, or dropped Medigap to try Medicare Advantage for the first time, and leave within the first 12 months (the "trial right").
• Your Medigap company goes bankrupt or ends your policy through no fault of yours, or misled you.

Keep the letter that shows when your coverage ends, and apply within the window, usually up to 63 days after the coverage ends.

In Oregon

Oregon's rule, OAR 836-052-0142, follows the federal events and adds a few protections. In Oregon:

• If you qualify, any company must offer you Plans A, B, C, D, F, high-deductible F, G, K, L, M or N (C and F only if you were first eligible for Medicare before 2020).
• Oregon's birthday rule (OAR 836-052-0143) gives anyone already in a Medigap policy a yearly window, from 30 days before to 30 days after their birthday, to switch to a policy with the same or lesser benefits, from the same or a different company, without health questions.
• If you have Medicare because of a disability and move to Oregon from a state that doesn't require Medigap for people under 65, you have 63 days from becoming an Oregon resident to buy a policy without health questions (OAR 836-052-0138).

For 2027, if your Medicare Advantage plan is ending, your guaranteed issue right lasts 63 days after it ends; see plans ending in 2027. Questions or complaints about a Medigap company go to the Oregon Division of Financial Regulation's consumer advocates, 1-888-877-4894.