Guaranteed issue rights allow you to purchase a Medicare Supplement plan without being turned away from the issuing insurance company. New Jersey offers protections for disabled Medicare beneficiaries under age 65 but does not extend guaranteed issue rights to people 65 or older who are not disabled.
Do I Have Guaranteed Issue Rights in New Jersey?
The answer to this question depends on why you qualify for Medicare. Are you turning 65 and just now enrolling in Medicare? Then you only qualify for a one-time window during your federally-mandated Medicare Supplement Open Enrollment period. This lasts for six months and begins when you are 65 or older and first enrolled in Medicare Part B. You have no further protections.
The state of New Jersey has put rules in place to protect the coverage options of disabled Medicare beneficiaries under the age of 65. If you are between ages 50 and 64 and qualify for Medicare because of a disability, you have six months from the time you enroll in Part B to enroll in the one available Medicare Supplement plans, during which time you have state-granted guaranteed issue rights. These rights protect your coverage and prevent the insurance companies from charging you higher premiums.
New Jersey Medicare Supplement Rules
- Disabled Medicare beneficiaries can apply for a Medigap plan within six months of enrolling in Part B and will have guaranteed issue coverage with no increase in price due to their disabilities.
- Disabled Medicare beneficiaries younger than 50 only have guaranteed issue coverage for Plan D from Horizon Blue Cross Blue Shield of New Jersey, the state’s contracted carrier.
- Disabled Medicare beneficiaries between 50 and 64 have guaranteed issue coverage for Plan D from any New Jersey insurer selling Medicare Supplement plans.
- To help cover the loss that the insurance companies take when offering coverage to these individuals, the state requires that insurance companies share in the loss of those under 50 and incur loss ratios of 65% for individual policies and 75% for group policies for people between 50 and 64.
New Jersey Guaranteed Issue Plan
The only guaranteed issue plan for disabled Medicare beneficiaries in New Jersey is Plan D. Plan D is considered a comprehensive Medicare Supplement plan. It offers coverage for:
- Part A coinsurance and hospital costs
- Part B copays and coinsurance
- Your first three pints of blood
- Part A hospice care
- Skilled nursing facility care
- Part A deductible
- 80% of foreign travel emergency care
How Can I Enroll in a Medicare Supplement Plan?
Enroll in a Medicare Supplement plan while you have guaranteed issue rights. These precious six-month windows allow you to purchase a Medicare Supplement plan without having to go through medical underwriting or being charged higher premiums because of either your age or disability.
These plans are standardized and offered by private insurance companies. To sign up for a plan, you must be enrolled in Medicare Part A and Part B and not be enrolled in a Medicare Advantage plan.
For help navigating your Medicare Supplement options in New Jersey, contact the experts at Jersey Medicare Solutions.
Thomas M. Brzezinski is one of the founding partners of WMAG William & Michael Advisor Group LLC and Jersey Insurance Solutions. He has been involved in the insurance industry for over ten years and specializes in developing client relationships that last a lifetime.
