In addition to your Medicare AEP (Annual Enrollment Period), Medicare beneficiaries also have an SEP or Medicare Special Election Period. If you are currently in a Medicare Advantage plan or MAPD, and the plan is withdrawing from the market you have the right to join another plan without penalty or health questions.
Medicare Special Election Period – SEP
Your Medicare Special Election Period begins when you are notified by your Advantage carrier that they are withdrawing from the market in your area and is terminating at the end of the year.
Other situations that can trigger an SEP include:
- You are enrolled in a MAPD or Part D and you disenroll during the Medicare Advantage Disenrollment Period
- If you leave your plans service area
- If you enroll during your ICEP (Initial Coverage Election Period) and you choose to disenroll during your first 12 months
- If you were covered under an employer plan and you lose that coverage
SEP and Guaranteed Issue
Your Medicare special election period gives you a GUARANTEED RIGHT to return to original Medicare and purchase a Medigap plan without submitting to underwriting. But there are other times when you can purchase a Medicare supplement plan on a guaranteed issue basis.
- If you have an Advantage plan and the plan withdraws from your market
- If you move out of the service area for your plan
- You have an employer group or retiree plan that pays secondary to Medicare and that plan is discontinued
- You enrolled in an Advantage plan during your ICEP and you voluntarily disenrolled during your first 12 months
- If your Medigap plan goes bankrupt, or you otherwise lose coverage through no fault of your own
- You voluntarily disenroll from an Advantage plan because you were misled about benefits or the carrier did not follow CMS rules
In each of the above situations you have a guaranteed right to buy a Medigap policy without answering questions about your health.
Under your guaranteed issue rights, the Medigap company
- Cannot refuse to sell you a policy
- Must cover your pre-existing condition
- Cannot charge you a higher premium due to past or present health problems
If you are involuntarily losing your Advantage plan, or you voluntarily withdraw under the conditions outlined above, you have up to 60 days following the end of your coverage to apply for new coverage and still retain your guaranteed issue rights. Your new Medigap coverage cannot begin until your current plan terminates.
Georgia Medicare Plans is ready to help you with your GA Medigap quotes and secure new coverage.
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