All About Guaranteed Issue Rights and Trial Rights

Medicare Supplement Plans for 2018 are protected by the Federal Law. The healthcare insurance policies are controlled by rights that can reduce the risks of denied coverage. Likewise, there are rights to prevent people from buying plans that are not appropriate for them. These rights are known as Guaranteed Issue Rights or Medigap Protection.

Understanding Guaranteed Issue Rights

Medigap Open Enrollment Period is the best time to buy a supplemental policy in your region. Though this is the ideal time to buy a healthcare insurance policy, you are allowed to make a purchase outside the enrollment month. The guaranteed issue right ensures that the policy is sold to those who are 65 years or older.

The Guaranteed Issue Right becomes useful if your existing coverage changes or fails to handle your medical expenses. When such a situation arises, the healthcare insurance company sells policies that can cover your medical condition. The healthcare insurance company is not allowed to charge more or amend the Medigap policy.

 

 

Important Situations to Remember

  • Your Medicare Advantage Plan is discontinued in your state. Or, your contract is terminated by the insurance company. Or, you have relocated to another state.
    1. In this situation, your Medigap Plan A, B, C, K, F, and L will switch to the Original Medicare plan.
    2. You will not be qualified to buy a supplemental plan if you decide to invest in an Advantage plan.
  • You have an active Medicare Part A and Part B policy. Additionally, you have COBRA or retiree coverage. Unfortunately, Medicare is your key insurance provider and your COBRA/retiree coverage is coming to an end.
    1. You should not wait till the COBRA plan comes to an end. Go ahead and buy a Medigap supplemental plan.
  • You have a Medicare SELECT plan. Unfortunately, you decide to move to another state.
    1. Before you shift, talk to your insurance service provider. Check if they have a solution for you.
  • Your insurance service provider fails you. They are unable to cover your medical expenses. Or, your healthcare insurance comes to an end and it is not your fault.
    1. In both these cases, you must invest in Medigap Supplement Plan A, B, C, F, K or L.

Using Guaranteed Trial Rights

Guaranteed trial right allows insurers to switch or buy back a Medicare Supplement Plan. However, you must buy the Medigap plan within a year of purchasing the Advantage plan.

Medicare Advantage Plans offers predicable cost benefits

When spending on healthcare is concerned, no individual will prefer uncertainty. Those enrolled in traditional Medicare are sure to know that this plan does come with some gaps in its coverage. It is termed to be a safety net and never was intended to pay up 100% of all covered services. Hence, cost sharing with traditional Medicare tends to include co-insurance and co-pays as well as hospital deductibles exclusively for outpatient services. The latter is considered to be the major area of uncertainty. Moreover, 20% medical expenses are to be borne by Medicare beneficiaries.

Why enroll with Medicare Advantage Plans?

One of the major reasons to enroll with Advantage plans is its predictable cost. Having Advantage plan, the individual is able to know in advance what his healthcare related expenses will be for the services availed.

Pre-determined co-pays are found in Medicare Advantage Plans for the services covered. Even though, the plan design is found to vary from one Advantage plan to the other one, medical services having co-pays are likely to include the following:

  • Urgent care visits
  • Specialist consultation
  • Primary care physician visits
  • Ambulance service
  • Few outpatient testing
  • Emergency room visit
  • Various types of Medicare covered services

By knowing in advance the approximate costs to be borne, is sure to help the individual to have peace of mind and take the right decisions in his/her favor. Besides this, by knowing individual responsibility, the best possible medical treatment can be sought.

Medicare Advantage Plans mean certainty

One major benefit offered by Advantage plan is an interesting feature which ensures the beneficiaries with annual maximum out of pocket amount. This feature is not offered by original Medicare. For outpatient services, the individual is responsible to bear 20% of all charges for availing covered services, irrespective of what it is.

Medicare Advantage Plans are known to provide dollar amount to indicate the maximum annual responsibility. Upon reaching the amount, through co-insurance, co-pays and deductibles, the person’s responsibility stops, as the plan start to pay up 100% of the covered expenses.

Often Advantage Plans are found to provide coverage for those extra services, which are otherwise not taken care of by Medicare like vision, dental, hearing and at times, health club memberships. Being on fixed income, such benefits can indeed make huge difference.

Medicare Advantage Plans in 2019 can be considered if the desire is to get a plan which ensures predictable costs.