What are the Guaranteed Issue Rules for when you are
new to Medicare as you’ve turned 65?
Guaranteed Acceptance Guide
Blue Shield CALIFORNIA
This is just a summary of the major reasons.
Check this entire page and website for all situations and Insurance Carriers.
- 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
- You enrolled with A Medicare Advantage Plan and the plan is being terminated;
- terminated from any employer-sponsored health plan,
- moved outside the plan’s service area.
- disenrolled from the plan or program within twelve (12) months of the effective date of that enrollment.
- You terminated enrollment in a Medicare Supplement plan and subsequently enrolled, for the first time, in any of the following:
• A Medicare Advantage Plan;
- MAPD Trial Privileges #02110 Medi-Gap Guide
- 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.
- 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;
- You are no longer eligible for Medi-Cal benefits.
- Birthday Rule
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Here’s Blue Shield rule from their Guaranteed Issue Guide:
Situation 1 You are:
• 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
Your plan choices Plan A, C, D, F, High Deductible F, K, or N When to apply
• If you are age 65 or older: Blue Shield must receive your application within six (6) months, beginning with the first day of the first month in which you are both age 65 or older, and you are enrolled for benefits under Medicare Part B.
• If you are age 64 or younger: Blue Shield must receive your application within six (6) months of your enrollment in Medicare Part B, or if you are notified retroactively of eligibility for Medicare, within six (6) months of notice of eligibility.
You must supply this documentation Be sure to fill out the following sections of your enrollment application:
• Medicare Parts A and B effective dates and your Medicare number.
• In addition, if you are age 64 or younger, please complete the Current Insurance Coverage information section indicating you do not have end-stage renal disease. Guaranteed Issue Guide
When’s the best time to buy a Medigap policy?
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. Publication 02110 Page 14
Medigap Open Enrollment Period—
A one‑time‑only, 6‑month period when federal law allows you to buy any Medigap policy you want that’s sold in your state. It starts in the first month that you’re covered under Medicare Part B, and you’re 65 or older. During this period, you can’t be denied a Medigap policy or charged more due to past or present health problems. Some states may have additional Open Enrollment rights under state law. Publication 02110 Page 45