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The ins and outs of Medicare supplement guaranteed issue plans

Dear Toni: I have decided to retire when I turn 65 in January and will need to enroll in Medicare Parts A and B. My husband, Sam, is 70 and enrolled in Medicare Parts A and B when he turned 65 and remained on my company benefits due to having health issues.

He recently began taking heart meds for blood clots, and his cardiologist’s office manager expressed concern over my husband’s insurance changes from group insurance to Medicare. Next year, he may have to have serious medical procedures.

Please explain how we enroll in our Medicare supplement plan. — Sheila, Omaha, Nebraska

Dear Sheila: Enrolling in Part B the wrong way, or too soon, can cause you not to qualify medically for the Medicare supplement you desire. This could be Sam’s situation.

Enrolling in Part B the correct way, when you or your spouse is working full time and you have company benefits, is so important. You want not only to avoid a Medicare Part B penalty; you also want to be able to enroll and be accepted by any Medicare supplement/Medigap plan by avoiding medical underwriting.

Normally, because Sam enrolled in Medicare Part B when he turned 65 over five years ago, he would have to answer the underwriting questions to qualify.

However, Medicare has special rules for employees, or their spouses, who are covered by an employer’s group health insurance. Sam is lucky: There is a Medicare supplement rule that allows him to avoid answering the underwriting questions.

Since he is leaving your company benefits, Sam qualifies for the 63-day guaranteed issue period to apply for a Medicare supplement/Medigap plan without medical underwriting. He will need your company benefit plan termination letter to prove that he is in a guaranteed issue period.

With guaranteed issue, an insurance company:

— Must sell you a Medigap/Medicare supplement policy. Sam has the right to buy Medigap/Medicare supplement Parts A, B, C, F, K or L, which are sold in your state by any insurance company. Sam is not eligible for Part G with guaranteed issue plans since his Medicare Part A began before Jan. 1, 2020. (Those whose Medicare Part A began after Jan. 1, 2020, are eligible for Part G, not Parts F or C, for a guaranteed issue plan.)

— Must cover all your pre-existing health conditions.

— Cannot charge you more for a Medigap/Medicare supplement policy, regardless of past or present health problems.

Sheila, since you are turning 65 in January, you will have a less stressful Medicare enrollment than Sam because you are in your Medicare supplement/Medigap open enrollment period. The “Medicare & You” handbook states: “The best time to purchase a Medicare Supplement/Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B.”

Many Americans do not realize that enrolling in Medicare Part B is as valuable as gold and should be treated carefully. Take your time, and remember to discuss your needs with your medical providers when exploring your Medicare plan options.

Toni King is an author and columnist on Medicare and health insurance issues. For a Medicare checkup, email info@tonisays.com or call 832-519-8664.

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