Guaranteed Issue Right - Buying a Medicare Supplement Plan Outside of Open Enrollment
If you are buying a Medicare supplement policy and you are not in your open enrollment period, some policies may still be available to you during some of the guaranteed issue periods described below.
- Each insurer must designate a one-month guaranteed issue period each year when any applicant will be accepted in Plan A. The insurer decides which month to designate. This chart shows the Guaranteed Issue Period for Plan A for all insurers selling Medicare Supplement Plans in Maine. Insurers are not required to offer other Medicare supplement plans during this period.
- Medicare supplement insurers must offer you a policy if you lose coverage under one of the following types of health plans and you apply for a Medicare supplement policy in Maine within 90 days:
- Individual health insurance plan (not including fixed indemnity or short term coverage)
- Employee welfare benefits plan (group health coverage through your employer)
- MaineCare (include QMB but does not include benefits that only provide Medicare Part B premium assistance; please refer to Bureau of Insurance Bulletin 385 (PDF) for additional guidance.)
Changing Medicare Supplement Plans
In Maine, you have the right to change Medicare supplement plans as long as you change to a plan with the same or lesser benefits from the same or a different insurer, and you have never had a gap in coverage that supplements Medicare of more than 90 days since your Open Enrollment Period. Under these circumstances, the insurer can't refuse to give you the coverage. See the Replacement Plan Chart to determine which plans are available to you, based on your current plan.
Switching From a Medicare Advantage Plan
You cannot purchase a Medicare supplement plan if you are enrolled in Medicare Advantage. If you are enrolled in a Medicare Advantage plan you may have a right under Maine law to enroll in a Medicare supplement plan if you switch back to original Medicare, but only under certain limited circumstances.
- You may be entitled to guaranteed issue of a Medicare Supplement policy if your Medicare Advantage plan is involuntarily terminated (i.e., not at your request).
- If you enroll in Medicare Advantage during your six-month open enrollment period, beginning when you first enroll in Medicare Part B, and then switch to Original Medicare Part A and Part B within 36 months:
- You have the right to buy any Medicare supplement plan as long as you buy it within 90 days after your Medicare Advantage coverage ends. Otherwise, it is generally up to the insurer whether or not to issue a policy, which means you may need to qualify based on health status. This arrangement is intended to provide you with a one time trial period to determine if a Medicare Advantage plan meets your needs. NOTE: If you enrolled in a Medicare Advantage plan mid-year, you will need to switch back to original Medicare sooner than 36 months years because federal law only allows you to go back to original Medicare at certain times. Also, Maine law extends the Medicare Advantage "trial period" from 12 months to 36 months, so you may not have the same rights if you move to another state.
- If you are enrolled in a Medicare Supplement plan and you terminate that enrollment in order to enroll in a Medicare Advantage plan for the first time, and you then return to Original Medicare Part A and Part B within 3 years:
- You have the right to buy an equivalent or less comprehensive Medicare supplement plan as long as you are still a Maine resident and apply for the new Medicare supplement plan within 90 days. (As noted above, if you enroll in Medicare Advantage mid-year and switch back, you will need to do so sooner than 36 months.)
For specific guidance on guaranteed issue eligibility, please see Maine Insurance Rule Chapter 275, § 12 or contact the Bureau of Insurance.
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