Medicare 2026

Medigap Guaranteed-Issue Rights: When an Insurance Company Must Sell You a Policy

If you have Original Medicare, a Medigap (Medicare Supplement) policy can help cover some of what Medicare does not — things like coinsurance and copays. But Medigap is sold by private insurers, and outside of certain protected windows, companies can look at your health history and either turn you down or charge you more. That is where "guaranteed-issue rights" come in. When one of these rights applies, an insurer must sell you certain Medigap policies, cannot refuse you because of past or present health problems, and must cover your pre-existing conditions.

Here is a plain-English look at how those rights work at the federal level, when they typically apply, and what to watch for.

What "guaranteed issue" actually means

Normally, when you apply for Medigap outside a protected window, an insurer can use medical underwriting. That means they can ask health questions and decide whether to accept you, decline you, or charge a higher premium.

Guaranteed issue flips that off. In a qualifying situation, the insurer:

• Must sell you a Medigap policy that it offers,
• Cannot deny you coverage based on your health,
• Cannot charge you more because of past or current health conditions, and
• Must cover your pre-existing conditions.

The catch is that guaranteed issue applies only to certain Medigap plan types and only in certain circumstances. It is not a year-round open door.

Your first big window: Medigap Open Enrollment at 65

The six-month Medigap Open Enrollment Period starts the month you are both 65 or older and enrolled in Medicare Part B. During this one-time window, you can buy any Medigap policy sold in your area, and the insurer must sell it to you without medical underwriting.

Many people consider this the most important Medigap window of their lives, because it is broad and does not require a special triggering event. If you miss it, your ability to buy Medigap later without health questions depends on whether you qualify for a separate guaranteed-issue right.

Federal guaranteed-issue situations

Federal law lists specific circumstances in which guaranteed issue kicks in. Two of the most common:

1. Your Medicare Advantage plan leaves Medicare or leaves your area. If your Medicare Advantage plan ends its contract with Medicare, pulls out of the area where you live, or otherwise stops offering coverage where you are, you generally get a guaranteed-issue right to buy certain Medigap policies. The window typically runs from 60 days before your coverage ends to 63 days after it ends. Acting inside that window matters — once it closes, insurers can go back to medical underwriting.

2. The "trial right" when you first try Medicare Advantage. If you joined a Medicare Advantage plan when you first became eligible for Medicare at 65, or if you dropped a Medigap policy to try Medicare Advantage for the first time, you have a 12-month trial period. If you decide within those first 12 months that you want to go back to Original Medicare, you have a guaranteed-issue right to buy certain Medigap policies.

There are additional federal guaranteed-issue situations — for example, certain cases where employer or union retiree coverage ends, or where an insurer goes out of business or misled you. The specifics (which Medigap plan types you can buy, exact timing, documentation) are laid out in CMS's Medigap guidance on Medicare.gov.

State rules can expand your rights

Federal law sets the floor, not the ceiling. Some states have added their own Medigap protections — for instance, "birthday rules" that give you an annual window to switch Medigap policies without underwriting, or rules that let you change carriers under broader conditions. These vary significantly from state to state, so it is worth confirming what applies where you live before you assume you are limited to the federal rules.

Medicare Advantage vs. Original Medicare + Medigap: a neutral look

Because guaranteed-issue rights often come up when people are deciding between coverage paths, it helps to see the trade-offs side by side without ranking them:

• Original Medicare + Medigap + a stand-alone Part D plan typically lets you see any provider that accepts Medicare and uses Medigap to smooth out cost-sharing. Premiums for Medigap and Part D are separate, and Medigap pricing can depend on when and how you enroll.
• Medicare Advantage bundles hospital, medical, and usually drug coverage through a private plan, often with networks and prior authorization, and sometimes includes extras. If you later want to switch back to Original Medicare with Medigap, your ability to get Medigap without health questions depends on whether a guaranteed-issue right applies.

Neither path is right for everyone. The best approach is to understand how each works with your providers, prescriptions, budget, and travel patterns, and to pay attention to how guaranteed-issue rules affect your future flexibility.

A quick note on 2027 program-level numbers

A few confirmed national figures are useful to keep in mind as you plan:

• The Part D out-of-pocket cap is $2,400 in 2027 (up from $2,100 in 2026).
• The maximum Part D deductible any plan may charge in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33, a national figure used in calculating the late-enrollment penalty; actual plan premiums are set plan by plan.
• Annual Enrollment for 2027 coverage runs October 15 – December 7, 2026, with changes effective January 1, 2027.
• Social Security announced a 3.6 percent COLA for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, had not been announced at the time of writing. CMS typically announces those in the fall.

Where to get the official details

Medigap rules — including the full federal list of guaranteed-issue situations, the Medigap plan letters involved, and what documentation to send — are explained on Medicare.gov under Medicare Supplement Insurance (Medigap). For personalized questions about your situation, you can call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week.

This article is for general education only. It is not affiliated with or endorsed by any government agency. It does not rank or recommend any insurance plan.