New 2020 Guaranteed Issue Chart – GI after MACRA changes go into effect
63-day guarantee issue for involuntary disenrollment:
Guaranteed Issue required if: |
Plans available for individual eligible for Medicare: |
|
| PRIOR to 1/1/2020 | On or After 1/1/2020 | |
| They are in a Medicare Advantage Plan (like an HMO or PPO), and the plan is leaving Medicare or stops giving care in their area, or they move out of the plan’s service area. | Plan A, B, C, F, K, or L that’s sold by any insurance company in their residence state. | Plan A, B, D, G, K, or L that’s sold by any insurance company in their residence state. |
| They have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. | Plan A, B, C, F, K, or L that’s sold by any insurance company in their residence state. | Plan A, B, D, G, K, or L that’s sold by any insurance company in their residence state. |
| They have Original Medicare and a Medicare SELECT policy and they move out of the Medicare SELECT policy’s service area. | Plan A, B, C, F, K, or L that’s sold by any insurance company in their current state or the state to which they are moving. | Plan A, B, D, G, K, or L that’s sold by any insurance company in their current state or the state to which they are moving. |
| (Trial right) They joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All-inclusive Care for the Elderly (PACE) when they were first eligible for Medicare Part A at 65, and within the first year of joining, they decide they want to switch to Original Medicare. | Any Plan sold by any company in their residence state. | Any Plan sold by any company in their residence state. |
| (Trial right) They dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, they’ve been in the plan less than a year, and you want to switch back. | The Plan they had before they joined the Medicate Advantage Plan or Medicare SELECT policy, if the original company still sells it. If the original company no longer sells the same plan, they can purchase Plan A, B, C, F, K or L that’s sold by any insurance company in their residence state. | The Plan they had before they joined the Medicate Advantage Plan or Medicare SELECT policy, if the original company still sells it. If the original company no longer sells the same plan, they can purchase Plan A, B, D, G, K or L that’s sold by any insurance company in their residence state. |
| Their Medigap insurance company goes bankrupt and they lose their coverage, or their Medigap policy coverage otherwise ends through no fault of their own. | Plan A, B, C, F, K, or L that’s sold by any insurance company in their residence state. | Plan A, B, D, G, K, or L that’s sold by any insurance company in their residence state. |
| They leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled them. | Plan A, B, C, F, K, or L that’s sold by any insurance company in their residence state. | Plan A, B, D, G, K, or L that’s sold by any insurance company in their residence state. |
Carriers that we have confirmed will honor this new MACRA GI chart for 1/1/2020:
UHC
Aetna
Americo
Assured Life
Bankers Fidelity
Cigna
Equitable
Great Southern Life
Heartland National
Humana
IAC
Medico/Medico Corp
Mutual of Omaha
Pan American
Shenandoah
Thrivent
Transamerica