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

 

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.

Loss of COBRA

You are also entitled to this protection when you become eligible for COBRA  (Our webpage on 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  *

COBRA and Medicare are VERY VERY confusing.  Double check with us on your specific situation!!!

 

 
 
 
 
Guaranteed Issue Loss of 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.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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;
or
• The employer no longer provides you with insurance that covers all of the payment for the 20% coinsurance.
 
 
 
 
 
Why is there Both situation 4 and 11?
 
 
 
I asked and was told # 11 applies to §419 (e) Welfare Benefit Plans 
 
 

Guaranteed Acceptance Guide
Blue Shield CALIFORNIA
Blue Cross CA

This is just a summary of the most common ways you can get a Medi Gap plan without having to answer health questions.

Get more detail at:

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

Guaranteed Acceptance – Medi-Gap – Supplemental Plans

On some pages you can Scroll down for our cut & paste of the ACTUAL CA Law

Employer loss of Coverage Guaranteed Issue
CA Insurance Code  §10192.11
 

(e)

(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.

Be careful and double check – COBRA might not get you out of the Part B Late Enrollment Penalty

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  *

11 comments on “Loss of Employer Coverage

  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?

    • The waiver of Pre X would be the same. Situation # 4 above says the enrollment period is 6 months. It gets QUITE confusing with different rules for different enrollments… Part B Outpatient, Part D Rx, Medicare Advantage, etc. One has to check each option with a fine tooth comb!

      See links above to enroll online with Blue Cross and Blue Shield.

      Here’s our scheduler to set a zoom meeting with screen sharing. https://steveshorr.com/intro/set-a-meeting/

  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.

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