[ad_1]
When it comes to health insurance for seniors, one of the largest concerns people have is not getting coverage of a 'pre-existing' condition.
Why is this a concern?
Because if things are not handled correctly with a change of insurance, a pre-existing condition may be excluded from coverage for a period of time. This means you must pay out of pocket for healthcare services for your condition. Depending upon the insurance company, this waiting period could have been minimal or last up to a year.
The mere thought of hundreds or sometimes even thousands of dollars out of pocket for healthcare bills is enough to keep anyone up at night.
(A pre-existing condition is defined as: "a health problem you had before the date that a new insurance policy starts." Usually an insurance company will look back 6-12 months (possibly up to 18) for treatment of a pre- existing condition.)
However, when it comes to Medicare Supplement (Medigap) Insurance, the government has made laws to protect you from being denied coverage if you happen to lose your health insurance coverage or have other qualifying events.
These protections are called "Guaranteed Issue Rights" and "Trial Rights."
Guaranteed Issue Rights mean that an insurance company is required by law to sell you a Medigap policy, must cover all your pre-existing conditions, and can not charge you more money based on your current or past health problems.
There are five Guaranteed Issue Rights.
You have a Guaranteed Issue Right in the following situations:
1.If you are enrolled in a Medicare Advantage Plan, ("Medicare Part C) and you either: move out of your plan's service area, your plan leaves Medicare or if your plan stops giving care in your area.
2.If you leave a Medicare Advantage Plan or Medigap policy because the policy or company does not follow the rules or misleads you.
3. If your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own
4. If you have a Medicare Select policy with Original Medicare and you move outside of the Medicare Select policy's coverage area.
5. If you are enrolled in Original Medicare (Parts A & B) combined with an employee / union / COBRA health insurance plan (that is a secondary payer to Medicare) and that plan is ending.
You also have 2 "Trial Rights" which give you the same protections as Guaranteed Issue. Here they are:
1. If you joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at age 65 and you decide you want to switch to Original Medicare within the first year of joining .
2. If you drop a Medigap policy to join a Medicare Advantage Plan (Medicare Part C) for the first time and you want to switch back to a Medigap within one year.
An important thing to keep in mind when it comes to Guaranteed Issue and Trial Rights is that there are critical time frames that you must adhere to. For instance, you typically have a maximum of 63 calendar days from the date your old coverage ends to buy a Medigap plan. If you take longer than 63 days, you may lose your Guaranteed Issue or Trial Rights.
Also, there are certain Medicap plans which the insurance companies are required to sell you under Guaranteed Issue. These plans are A, B, C, F, K, or L. Four other Medigap plans (D, G, M and N) are not included in the Guaranteed Issue / Trial Rights.
My goal here is simply to provide a 'plain English' overview. To learn all the details about these protections, you can visit Medicare.gov.
I think it's very important that those age 65 and over know what their rights are and how to use them for maximum cost savings.
Here's an example:
If you did have a guaranteed issue right and you did not use it, you could be subject to higher premiums and / or greater out of pocket costs than necessary.
And remember to keep copies of anything you get in the mail from insurance companies. Notices, letters and claim information. Keep the envelopes, too, so you have proof of when it was delivered to you.
All it takes is a little knowledge to help save you money.
