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Timing of the Open Enrollment Period
The CMS bulletin clarifies that the 6 month Medigap
open enrollment period begins for an individual on the first day of the first month after he/she has both a) attained age
65 and b) become entitled to Medicare Part B benefits.
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An individual attains age 65 on the first
day of the month in which the individual ’s 65th birthday falls. For example, an individual whose 65th birthday is October
15, 2003 will be deemed to have attained age 65 on October 1, 2003. Exception: For an individual whose
birthday falls on the first day of the month, he/she is deemed to have attained age 65 on the first day of the previous month.
For example, an individual whose 65th birthday is October 1, 2003 will be deemed to have attained age 65 on September 1, 2003.
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An individual becomes entitled to Medicare
Part B benefits when he/she has been accepted into the Medicare program. An individual’s Medicare card will indicate
the date on which he/she became entitled to Part B benefits. (The date on which an individual applies for Medicare is generally
not the same as the date on which he/she becomes entitled to benefits.)
GUARANTEED ISSUE:
If you are losing your employer group health insurance coverage, through no fault or decision of your own,
you may be entitled to purchase a Medicare supplement policy without having to answer underwriting (health) questions during
the first 63 days after you receive notice that your group policy is going to end, up to 63 days after the group policy has
ended. This entitlement is referred to as "guarantee issue" and is called a "guaranteed issue" period. "Guarantee issue" means
you have the right to enroll into a Medicare supplement policy within a 63-day period and the insurance company cannot refuse
to issue a policy to you, regardless of your health. However, a prescription drug rider can be denied in a guaranteed issue
period. (In an open enrollment period the prescription drug rider cannot be denied).
EVENTS THAT MAY TRIGGER A GUARANTEED ISSUE PERIOD:
1. You are enrolled in an employer group health benefit plan, and the plan terminates or ceases to
provide some or all health benefits to you.
2. You are currently enrolled in a Medicare Plus Choice or Medicare select health insurance plan and you
are moving from their service area. You should keep your current plan until you actually obtain new insurance in your new
location. You will be covered for emergency and urgently needed care under your old policy. The new company has to issue a
policy to you and you will not have to answer any health questions. In most circumstances, you will not have to serve a pre-existing
condition waiting period. Call a counselor to discuss your special circumstances.
3. You are in a trial period with a Part C Medicare Plus Choice plan and want to purchase a regular Medicare
supplement insurance policy.
CREDITABLE COVERAGE:
Creditable Coverage is the term given to the time or "credit" you are granted for the time you have been enrolled in and
covered by qualified health insurance coverage. Having creditable coverage means you will not have to serve a pre-existing
condition waiting period. Creditable coverage only applies in situations where you are losing employer group health coverage
and you want to go into the HIRSP plan or into another employer group plan. For the HIRSP plan you must have had qualified
coverage for the previous 18 months. There cannot be more than 63 days between the time your prior coverage ends and the day
you apply for the HIRSP coverage.
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