Know guaranteed issue rules when choosing a plan

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.

Michael Pramik

Michael Pramik is communication strategist for the Ohio Public Employees Retirement System and editor of the PERSpective blog. As an experienced business journalist, he clarifies complex pension policies and helps members make smart choices to secure their retirement.

Michael Pramik

Communication Strategist

  • Does the guaranteed issue apply to spouses that are now covered by OPERS health plan and will transition to the connector?

  • I live in Pennsylvania now and because my husband is still employed and has health care, I have never used my OPERS health care plan. We are both 68 and when he retires in August of 2016 I will then sign up for a medicare advantage plan with the help of the connector ( i hope) will I have guaranteed issue?
    And will I have problems signing up for the first time since I will not be going through an open enrollment period. I think my situation is complicated. Advise. Thank you. My husband will be under his own plan.

    • Virginia,

      As stated in the blog, “It’s also true of participants who age into Medicare and for those who work beyond 65.

      You can sign up if there is a change in your insurance, such as your husband retiring, although you might want to go to http://www.medicare.gov to become more familiar with Medicare’s rules.

      –Ohio PERS

  • I have been researching Medicare.gov and OSHIP sites regarding Medigap coverage in Ohio and specifically in my zip code. Some of the Medigap insurances have a pre-existing waiting period of 3-6 months. I have not seen this issued addressed in any communication from OPERS. Will the pre-existing waiting periods for these Medigap insurance policies be waived to a no pre-existing waiting period since OPERS is ending their Humana contract coverage for Medicare retirees?

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