Tip for Insurer-specific (guaranteed issue)

Guaranteed issue means the insurer CANNOT deny you, charge more, or impose a waiting period for pre-existing conditions

Tip for Insurer-specific (guaranteed issue)

Common qualifying events: MA plan leaves your area, you move out of your plan's service area, you lose employer group coverage

Tip for Insurer-specific (guaranteed issue)

You must apply within 63 days of the qualifying event — do not miss this window

Medicaremoderate

Medigap Guaranteed Issue Request

Insurer-specific (guaranteed issue) · Private insurance companies

Application exercising guaranteed issue rights when leaving an MA plan, losing employer coverage, or plan discontinuation. 63-day window applies.

Form Details

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Where to Submit This Form

📬

Mail to the Medigap insurer

Inform the insurer of your guaranteed issue right and provide documentation of the qualifying event.

🏢

Through a licensed agent or your SHIP counselor

https://www.shiphelp.org/

Filing Deadline

Typically 63 days from the qualifying event (e.g., losing employer coverage, MA plan leaving your area, plan violation). Some events have different windows.

Required Attachments

📎 Completed Medigap application
📎 Proof of the qualifying event (termination of prior coverage letter, plan withdrawal notice)
📎 Proof of Medicare Part A and Part B enrollment

Processing Time

1-2 weeks. No medical underwriting — you cannot be denied.

What Happens Next

The insurer must accept your application at the standard rate without medical underwriting. Coverage starts based on the effective date of the qualifying event.

Tips for This Form

✓ Guaranteed issue means the insurer CANNOT deny you, charge more, or impose a waiting period for pre-existing conditions
✓ Common qualifying events: MA plan leaves your area, you move out of your plan's service area, you lose employer group coverage
✓ You must apply within 63 days of the qualifying event — do not miss this window
✓ Contact SHIP (shiphelp.org) for help determining if you have a guaranteed issue right

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