The short answer
A Medigap guaranteed issue right means an insurer must sell you a listed Medigap policy, cover pre-existing conditions with no waiting period, and cannot charge more because of your health. Federal triggers are tied to losing or leaving other coverage. In most cases you must apply no more than 63 days after that coverage ends, and Medicare Advantage triggers let you apply up to 60 days early.
- Deadline: Apply no more than 63 days after the qualifying coverage ends; Medicare Advantage triggers open 60 days before the end date
- Plan letters: Medigap A, B, C, D, F or G, with C and F closed to people first eligible for Medicare on or after January 1, 2020
- Trial right: 12 months from the start of your first Medicare Advantage plan to return to Original Medicare with guaranteed issue
- State add-ons: Maryland gives a yearly window on your birthday plus 30 days; Washington allows equal-or-lesser switches year-round
Applies to people with Medicare who are losing or leaving other coverage and want a Medigap policy without medical underwriting; under-65 access and extra switching windows vary by state.
What is a Medigap guaranteed issue right, and how does it differ from a birthday rule?
A guaranteed issue right is a federal protection that fires once per qualifying event. The insurer must sell you a listed Medigap policy and cannot impose a pre-existing condition waiting period. A state birthday rule is different: it repeats every year and usually limits you to equal or lesser benefits.
If you buy a Medigap policy when you have a guaranteed issue right, the company must cover all your pre-existing health conditions without a waiting period. That is the practical value. Health questions disappear, and so does the six-month look-back many applicants run into outside these windows.
The gap people miss is that federal law protects coverage losses, not shopping. KFF reports that beneficiaries who already have Medigap do not have federal guaranteed issue protection to switch policies, and none if they voluntarily drop Medigap and want it back later. That is where state rules take over, and our comparison of the Illinois 45-day birthday rule against federal 63-day rights shows how differently the two clocks run.
Which 10 situations trigger federal guaranteed issue rights?
The CMS chart groups the triggers into a handful of rows, but each row holds separate events with separate start dates. Broken apart, there are 10 distinct federal triggers, and eight of them involve coverage ending for reasons outside your control.
- Your Medicare Advantage plan leaves Medicare or stops giving care in your area.
- You move out of your Medicare Advantage plan’s service area.
- CMS determines that your Medicare Advantage plan had a significant change in its provider network, which creates a special election period with Medigap guaranteed issue rights.
- Your employer group health plan, including retiree, COBRA or union coverage that pays after Medicare, is ending.
- You elected COBRA instead of buying Medigap and later exhausted it. A CMS bulletin confirms a second guaranteed issue period when the individual subsequently exhausts the COBRA benefits.
- You have a Medicare SELECT policy and move out of its service area.
- Trial right one: you joined Medicare Advantage or PACE when first eligible and leave within 12 months.
- Trial right two: you dropped a Medigap policy to try Medicare Advantage and, within a year of first signing up, disenroll to return to traditional Medicare and buy that same policy back.
- Your Medigap company goes bankrupt or your coverage ends through no fault of your own.
- Your Medigap insurance company commits fraud, or you left a plan because the company broke the rules or misled you.
Trigger three is the newest in practice and the least known. When a large health system drops a contract mid-year, affected members may qualify, which is worth checking against our coverage of carriers dropping Medicare Advantage plans for 2027.
How many days do you have to act after each trigger?
Most windows run 63 days from the day the old coverage ends. Medicare Advantage triggers open earlier, and the employer group row counts from the latest of several dates. The trial rights add a separate 12-month eligibility test before the 63-day application clock even starts.
| Trigger | Earliest you can apply | Last day to apply |
|---|---|---|
| Medicare Advantage plan exit, move, or significant network change | 60 days before coverage ends | 63 days after coverage ends |
| Employer, retiree, union or COBRA coverage ending | When you get the termination notice | 63 days after the latest of the three dates in the CMS chart |
| Medicare SELECT policy, you move out of the area | Day the coverage ends | 63 days after coverage ends |
| Trial right, first Medicare Advantage plan or PACE | 60 days before your disenrollment date | 63 days after coverage ends, within the first 12 months |
| Medigap insurer bankruptcy, fraud or rule violation | Day the coverage ends | 63 days after coverage ends |
| Medigap Open Enrollment at 65, for contrast | Month you are 65 and enrolled in Part B | 6 months, any plan sold in your state |
A Nevada Division of Insurance notice relaying CMS guidance states the guaranteed issue rights begin 60 days before the Medicare Advantage plan coverage ends and end 63 days after it ends. The CMS chart sets the employer group deadline at no more than 63 days after the latest of three listed dates. If you are weighing the move now, our breakdown of switching from Medicare Advantage to Medigap under the 63-day rule walks through the sequencing.
Can an insurer deny you or charge you more during a guaranteed issue period?
No, inside the window and inside the listed plan letters. Indiana’s SHIP states that during the 63-day window companies cannot turn you down, delay processing the application, charge you more, or put pre-existing limits on your policy, and that the guarantee goes away if you do not act within 63 days.
The letters you can buy depend on when you became eligible. Guaranteed issue covers Medigap plans A, B, C, D, G and F, with plans C and F closed to people who turned 65 after January 1, 2020, and plans D and G unavailable to those who turned 65 before that date. Premiums still differ by company and state, so quote the same letter across carriers.
Which states add guaranteed issue protections beyond the federal list?
Several do, and the rules are not uniform. KFF reports that Delaware, Illinois, Minnesota and Rhode Island have expanded guaranteed issue protections, and other states run annual birthday windows. Medigap underwriting, under-65 access and switching rights are set state by state.
Two examples show the range. Washington requires insurers to let policyholders switch to a policy with equal or less generous benefits at any time of year if there is less than a 90-day gap, with Plan A holders limited to another Plan A and Plans B through N able to move to any other B through N. Maryland grants a once-yearly open enrollment period that includes the policyholder’s birthday and the following 30 days, which a carrier may extend, and the application must be submitted during that period.
Illinois, Indiana, Utah and Virginia have added birthday-style windows in recent sessions, with different lengths and different limits on changing carriers. Our Medigap rules by state tracker and the state-by-state Medigap switching checker stay closer to the statutes than any national summary can.
What documents prove you qualify for guaranteed issue?
Insurers do not take your word for it. Every guaranteed issue application needs proof of what ended and when, and the file is usually a single letter plus a date. Collect these before you apply, because reissuing a termination notice can take weeks you do not have.
Your guaranteed issue documentation checklist
- Save the plan or employer termination letter, including the envelope date and the stated coverage end date.
- Write the end date on a calendar, then count forward 63 days and mark the last day to apply.
- Pull your Medicare card and confirm your Part A and Part B effective dates.
- For a trial right, find the start date of your first Medicare Advantage plan and, if you had Medigap before, the old policy number and carrier.
- Submit the Medigap application with the proof attached, and do not cancel anything until the new policy is issued in writing.
- Keep copies of everything for 12 months in case the carrier asks for the trigger again.
CMS notes that you may have additional rights under state law and points consumers to their State Insurance Department. That is the right final check, because the federal list is the floor, not the ceiling.
Questions people ask
Does the 63-day window extend my current coverage?
No. The window is only the period to apply for Medigap. Indiana's SHIP warns that the 63-day protection does not extend the health coverage that is ending, so apply early enough to avoid paying claims out of pocket during the gap.
Can I use a guaranteed issue right to move from Plan N up to Plan G?
Federal rights give you a listed set of plan letters tied to the trigger, not a free upgrade. KFF reports that beneficiaries who already hold a Medigap policy have no federal guaranteed issue protection simply to switch policies. Some states allow equal or lesser switches only.
What if I voluntarily drop my retiree coverage?
That usually ends the protection. KFF notes there is no federal guaranteed issue right when retiree coverage merely changes or when you drop it yourself. The right attaches when the employer cancels the coverage, so keep the termination letter the plan sends you.
Do guaranteed issue rights work the same under 65?
Not everywhere. Medigap access for people under 65 is set by state law, and some states require insurers to offer policies while others do not. Check your state's rules before you leave a Medicare Advantage plan, because a denial at 62 is not reversible.
Does Medicare Advantage Open Enrollment create a guaranteed issue right?
No. Medicare Advantage Open Enrollment runs January 1 to March 31 and lets you leave a Medicare Advantage plan. Buying Medigap without underwriting still requires a separate trigger, such as a 12-month trial right or a plan exit.
Can I apply before my old coverage ends?
Yes, for Medicare Advantage triggers. A Nevada Division of Insurance notice relaying CMS guidance states the rights begin 60 days before Medicare Advantage coverage ends and end 63 days after. Your Medigap policy still cannot start until the Medicare Advantage coverage stops.
Sources
- Choosing a Medigap Policy (CMS Publication 02110), 2026 edition
- CMS, Medigap (Medicare Supplement Health Insurance) and NAIC FAQ on significant network change, FAQ dated December 17, 2024
- Nevada Division of Insurance, Notice of Significant Change in Provider Network relaying CMS guidance, Effective October 16, 2025
- Maryland Insurance Administration, Medicare Birthday Rule, Effective July 1, 2023
- Colorado Division of Insurance, Medigap guide, 2025-2026 edition
- KFF, Medigap Guaranteed Issue Requirements: An Overview of Federal and State Rules, 2026
Not sure which trigger you qualify under?
Bring the letter from your plan or employer and your coverage end date, and we will map it to the federal trigger, the exact last day to apply, and the plan letters open to you in your state. We work by phone and video, and we are licensed in 40-plus states, not California.
Request a Medigap eligibility reviewCall or text (773) 657-9140Smart Insurance Agents LLC is an independent, licensed insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program for information on all of your options. Content is for general information and is not a guarantee of coverage or rates; figures are subject to change by CMS and carriers.