Guaranteed Issue Rights for Medi-Gap
when you enroll beyond age 65 for Part B
as you had Qualifying Employer Coverage

Guaranteed Acceptance Guide

This is just a summary of the major reasons.  Check this entire page and website for all situations and Insurance Carriers.

  1. Enrolled in Medicare and are age 65 or older; or  New to Medicare, are age 64 or younger, and do not have end-stage renal disease
  2. You enrolled with  A Medicare Advantage Plan and the plan is being terminated;
  3. terminated from any employer-sponsored health plan,
  4. moved outside the plan’s service area.
  5. disenrolled from the plan or program within twelve (12) months of the effective date of that enrollment.
  6. You terminated enrollment in a Medicare Supplement plan and subsequently enrolled, for the first time, in any of the following:
    • A Medicare Advantage Plan;
    1. MAPD Trial Privileges #02110 Medi-Gap Guide
  7. The company substantially violated a material provision of the contract; or
    • The company or its agent materially misrepresented a provision of the plan in marketing the contract to you.
  8. You enrolled in a Blue Shield Medicare Advantage Plan, and Blue Shield either:
    Reduced any of its benefits;
    • Increased the amount of cost-sharing or premium; 
  9. You are no longer eligible for Medi-Cal benefits.


CA Health Care Advocates
Federal Choosing a Medi Gap Policy  #02110
Guaranteed Acceptance Guide Blue Shield

What Plan F pays in addition to Medicare Parts A & B

What Plan F pays in addition to Medicare Parts A & B
Check our Carrier Pages for the latest Info
Anthem Blue Cross
Blue Shield – Medi-Gap

See also Plan G after 1.1.2020
same except for Part B deductible

Medicare & You – Federal Publication


Federal Rights to buy a Medi-Gap Policy

Federal Rights to buy a Medi-Gap Policy  - 02110 

See also CA Rights 

Video Introduction by Steve done circa 2013 double check any facts or benefits

Situation  1 from Blue Shield CA Guaranteed Acceptance Guide

Situation 1 - New to Part B
Situation 1 – New to Part B

Learn More about not enrolling in Part B if you have employer coverage

You received notice of termination, or your coverage was terminated from any employer-sponsored health plan, including an employer-sponsored retiree health plan. This includes termination for loss of eligibility due to divorce or death of a spouse.
Your plan choices
Plan A, C, D, F, High Deductible F, K, or N
When to apply Blue Shield must receive your application within six (6) months of the notice of termination, or if no notice is received, within six (6) months  of the date your employer-sponsored health coverage ended.
You must supply this documentation
Be sure to complete the Current Insurance Coverage information section (including the end date) of your signed Medicare Supplement plan application

Termination of Employment or Retirement Plan

You have the right to purchase a Medigap policy for 6 months if your, your spouse’s or a family member’s current employment or retirement plan coverage terminatesor you lose your eligibility due to divorce or death of a spouse or family member. The 6-month period to apply for a Medigap policy starts on the date you receive notice that your health benefits will end. If you do not receive advance notice, the 6-month period starts the date the benefits end or the date of your first denied claim. This protection of California law applies whether your group health benefits were primary or secondary to Medicare.

Note: You are also entitled to this protection when you become eligible for COBRA or have used up all your COBRA benefits. It does not apply if you stop paying COBRA premiums before you use all your benefits. COBRA benefits are always secondary to Medicare benefits unless you have ESRD and are in a 30-month coordination period. For more information on COBRA, see Medicare & Other Health InsuranceCA HealthCare Advocates  *

You enrolled in an employer-sponsored health plan that supplements Medicare, [§419 (e) Welfare Benefit Plans ] and either of the following apply:
• The plan either terminates or ceases to provide all of those supplemental health benefits to you;
• The employer no longer provides you with insurance that covers all of the payment for the 20% coinsurance.
Your plan choices
Plan A, C, D, F, High Deductible F, K, or N
When to apply
You may submit an application to Blue Shield during the guaranteed acceptance period, which starts from the later of the following two dates, and ends sixty-three (63) days after the date coverage is terminated:
• The date you received a notice of termination, or if no notice is received, on the date you received notice denying the claim because of
termination of benefits;
• The date coverage is terminated.
You must supply this documentation
Be sure to complete the Current Insurance Coverage information section  (including the end date and reason for coverage ending) of your signed Medicare Supplement plan application.
Why is there Both situation 4 and 11?
I asked and was told # 11 applies to §419 (e) Welfare Benefit Plans 
See everything in the  Blue Shield Guaranteed Issue Guide
CA Insurance Code  §10192.11


(1) An individual enrolled in Medicare Part B is entitled to open enrollment described in this section for six months following:

(A) Receipt of a notice of termination or, if no notice is received, the effective date of termination from any employer-sponsored health plan including an employer-sponsored retiree health plan.

(B) Receipt of a notice of loss of eligibility due to the divorce or death of a spouse or, if no notice is received, the effective date of loss of eligibility due to the divorce or death of a spouse, from any employer-sponsored health plan including an employer-sponsored retiree health plan.

(C) Termination of health care services for a military retiree or the retiree’s Medicare eligible spouse or dependent as a result of a military base closure or loss of access to health care services because the base no longer offers services or because the individual relocates.

(2) For purposes of this subdivision, “employer-sponsored retiree health plan” includes any coverage for medical expenses, including, but not limited to, coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and the California Continuation Benefits Replacement Act (Cal-COBRA), that is directly or indirectly sponsored or established by an employer for employees or retirees, their spouses, dependents, or other included insureds.

Resources & Links
Technical Memo:
Interaction between COBRA and Medigap Guaranteed Issue Requirements in Situations Involving Termination of Employer Group Coverage
Medicare.Gov  *  Next Page  *  All Federal Guaranteed Issue Rights  *  Federal Rights in HTML Matrix  *

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx 


Understanding your Medicare Choices
Medi Gap vs Medicare Advantage


How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS

Don't like computers?
Prefer a printed version be mailed to you?
Audio MP 3  

Use our scheduler to Set a phone, Skype or Face to Face meeting
Intake Form - We can better prepare for the meeting

Blue Shield Authorized Agent
No extra charge to you -
Click to learn more and enroll online


Paper Application 65 Plus, Choice & Trio
Medi Gap 

Click here to set a phone, skype or face to face complementary consultation 

Get Plan Documents 
Be sure though to use THIS link to enroll, so we get paid for helping you!

Anthem Blue Cross Authroized agent

Authorized Blue Cross Anthem Agent # GFKGQSJSRZ
Blue Cross pays us, no charge to you   
Instant Enrollment & Full Information

Click here to set a phone, skype or face to face complementary consultation 

11 comments on “Loss of Employer Coverage – New to Part B

  1. Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?

  2. I already have Medicare A and want part B. I am covered by a federal employee health plan (FEHB). Medicare (SSA) says I need to have a form filled out by my company president to verify employment- my W2 and tax form indicating coverage is not enough. Online it says my Medicare part B won’t start until July.

  3. This is utterly confusing. It says six month period of eligibility but that you must apply within 63 days of termination? Makes no sense to me.

    • Right. Please send a copy of your termination notice and if at all possible, all documents from your Employer’s Health Plan. Don’t hold back. We need to see if your under situation 4 or 11.

      Did the plan supplement Medicare or not?

  4. If one gets terminated from their spouses retiree benefits plan when the spouse passes away is there a guaranteed enrollment period into Medi Gap and how does it work?

  5. If you cancel your Part B, then you to reinstate Part B later will you have guaranteed issue rights for Medi Gap?

    • Good POINT!

      Excerpt from Medicare Medi Gap Guide # 02110 * Medicare.Gov *

      It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B. If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B and it can’t be changed or repeated.

      In most cases, it makes sense to enroll in Part B and purchase a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and you might miss your Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.

      From prior conversations and emails, you’ve stated that you have an application pending for Part B, but have not been enrolled. I’d check and see if you can get the application cancelled, as if you never asked to be enrolled in Part B.

      Either you or I can write to HICAP – CA Advocates and see what light they can put on the subject.

Leave a Reply

Your email address will not be published. logo