The Ohio Public Employees Retirement System is turning to the OPERS Medicare Connector beginning in January to provide health care coverage for eligible members 65 and older. One of the questions we see often is about “guaranteed issue” – can you be denied coverage at any time?
Guaranteed issue is a policy offered to eligible applicants without regard to health status. When we shut down our over-65 group plan and switch to the Connector, guaranteed issue is in place so that no members can be denied coverage, as long as they enroll during the open enrollment period from October through December this year.
It’s also true of participants who age into Medicare and for those who work beyond 65. Finally, guaranteed issue is in place for re-employed retirees who go back to work into employer-sponsored coverage or into OPERS re-employed retiree coverage. When members do finally retire, they will have a special enrollment period with guaranteed issue.
However, after you enroll, if you want to change your Medicare plan selection in future enrollment periods, there are some rules that come into play. First, Medicare Advantage plans always have guaranteed issue, as do drug plans. But for those who might have chosen a Medicare Advantage plan and a few years later want to move to a Medigap plan, those folks might have to go through medical underwriting.
This is not true if a selected Medicare Advantage Plan is leaving Medicare or ceases operation in your area. There are other situations in which guaranteed issue must be provided. Participants who are initially signing up for the Connector will want to carefully consider all their options when choosing a plan.
For more information, the Medicare.gov website has a section on guaranteed issue rights. Also, our November health care video chat with OPERS Health Care Director Marianne Steger addresses the issue of medical underwriting.