Guaranteed Issue Rights Denied

Guaranteed Issue Rights Denied: Protecting Seniors When Medicare Plans Are Non-Renewed or Terminated

 Mike Roth interviews Bill Kadereit about Guaranteed Issue Rights (GIR) being denied when Medicare Advantage, Medigap, or Part D plans are non-renewed, terminated, or become unavailable after a move to another state. Kadereit explains key differences between non-renewal and termination and describes how insurers often “crosswalk” members into new plans without providing required GIR notices, limiting seniors’ ability to shop. He cites large-scale disruptions, including millions affected by 2025 terminations and non-renewals, and a Blue Cross Blue Shield of Michigan example, arguing seniors with chronic conditions can face rejection or higher costs without GIR protections. The discussion highlights weak enforcement, confusion between state and CMS responsibility, criminal/civil penalties that are not applied, and NRLN’s efforts through white papers, CMS meetings, and plans to involve attorneys general while urging seniors to report missing or inadequate notices.

00:00 Welcome and Topic

00:18 GIR Basics Explained

01:05 Nonrenewal vs Termination

01:43 Moving States Eligibility

03:06 Crosswalking Trap

04:35 Scale of the Problem

07:09 Join and Report Cancellations

09:20 Why Costs Are Rising

10:37 Penalties and No Enforcement

11:59 Who Enforces the Rules

13:26 SEP and Golden Ticket Rights

17:20 Company Plan Terminations

20:07 ACA Gap and Trial Rights

21:39 NRLN Actions and Next Steps

24:09 Wrap Up and Closing

Transcript

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Mike Roth ai: 0:09

This is Mike Roth on Creating Better Lives for seniors. I'm here with Bill Kadereit. Bill, thanks for joining us.

Bill Kadereit: 0:17

Glad to be here, Mike.

Mike Roth ai: 0:18

Today we're going to be talking about Guaranteed Issue Rights (GIR) denied. This is a tough subject and we're gonna spend 30 minutes on it. This is going to be an extremely important because. If you are canceled by an insurance company because they're no longer writing policies in your zip code, you have a guaranteed issue. Bill, correct me if I'm wrong, but I believe if they move from one state to another, if they move from Wisconsin or Texas to The Villages, Florida do they get a guaranteed issue? Again,

Bill Kadereit: 0:57

and I think it's important to explain these. Differences in detail upfront because people don't sometimes understand if they're eligible or not. The terminology is, if they non-renew. Non-renew means that you had the plan last year, but this year they're not gonna make it available to you in your county. However, in the next county, they may make it available. And the reason why plans are non-renewed or terminated. Is because the insurance companies aren't making any money.

Mike Roth ai: 1:27

Right?

Bill Kadereit: 1:28

So that's a non-renewal. A termination is where they actually terminate the plan. They don't use it anywhere. So the difference between non-renewal and termination are differentiated that way.

Mike Roth ai: 1:38

So do you have any guaranteed rights if your plan is terminated?

Bill Kadereit: 1:42

Yeah. You do. And I want to explain the third element, which you hit on basically is if you move from one state to the other and the plan that you have is not available in your. The state you moved to, you are also eligible for,

Mike Roth ai: 1:57

so let's say I had a plan in Ohio

Bill Kadereit: 2:00

Yes.

Mike Roth ai: 2:00

With Aetna and I moved to The Villages and Aetna doesn't issue plans in this zip code. I have guaranteed rights to choose between any of the advantage plans or a traditional Medicare approach.

Bill Kadereit: 2:16

That's correct.

Mike Roth ai: 2:17

Okay, that's good.

Bill Kadereit: 2:18

So this episode covers the context for the AREF and NRLN White paper, which is posted on www.nrln.org under the legislative agenda, where you'll find a list of all of our white papers and our advocacy for to protect retirees. From losing Medicare Advantage and Prescription Drug and Medigap plans are tied to those papers.

Mike Roth ai: 2:45

Is a guaranteed issue, right?

Bill Kadereit: 2:48

That's correct, Mike.

Mike Roth ai: 2:49

Okay.

Bill Kadereit: 2:50

To see that if you get a GIR it is basically your golden ticket. It protects you in many ways, and we'll get through some of those in just a minute.

Mike Roth ai: 3:01

I guess I don't understand what the problem is. Can you give our listeners an example Bill?

Bill Kadereit: 3:06

Okay. Seniors with chronic medical problems and other risks are being outright rejected or charged exorbitant premiums in copays if they lose their plan. For example, blue Cross Blue Shield of Michigan announced in 2026. A non-renew of a Medicare Advantage plan in over 15 counties, but kept that plan alive for people who lived in adjacent counties and all other counties in Michigan to where it was profitable. The trap that sets is that the affected members weren't offered a guarantee issue. Instead, they were immediately crosswalked, and that's a common term in the insurance industry, people are switched into different profitable plans by insurers or their agents immediately. But they don't send you the GIR and they walk into your front door and say, boy, I got a better plan for you. It's a little more expensive. And it's called crosswalking them into a new plan without giving them the right to shop for themselves. So that practice prevents seniors from using their GIR to shop on the open market for a better deal on the Center for Medicare Services website.

Mike Roth ai: 4:14

So what is a ship?

Bill Kadereit: 4:16

It's a state health insurance plan counselor.

Mike Roth ai: 4:19

So it was a state counselor from Iowa that called, had called you? Okay. Are there any other personal anecdotal stories about violations that you've heard?

Bill Kadereit: 4:29

Yeah. It crosswalking and and all of these practices are very relevant today. In 2025, for example, planned terminations caused 1.2 million people. Seniors to lose coverage this year, announced in 2025 for this year, another 2.6 million seniors. Were dropped from their plans because they were either non-renewed, terminated, or they moved to another state. This year we will learn about a next wave of termination soon, by September 20th specifically. And though many letters will arrive earlier because seven 20, September 20 is a deadline. And so last year, for example, right about now. End of July, first part of August, people started getting their letters, and that's why we want to talk to you about this. Early long before the the 2020 5 26 enrollment period 163,000 of our members were affected in 2023 and 24. That's a lot of people, if they had received a GIR to find better deal. They could have saved up to 30%, nearly $1 billion in lifetime savings. So this is not a small deal.

Mike Roth ai: 5:46

Now, the National Retirees Legislative Network doesn't have every retiree in America as a member.

Bill Kadereit: 5:56

That's correct.

Mike Roth ai: 5:56

Should the non-members join?

Bill Kadereit: 5:58

If they want us to be engaged and for yes, on their behalf, they should help because we ask them to send action alerts and act, ask them to talk to their elected representatives and put the pressure on,

Mike Roth ai: 6:11

but

Bill Kadereit: 6:11

to make changes so that they are protected.

Mike Roth ai: 6:14

Yeah. But 163,000 members were affected and. We have a small percentage of the senior population as members.

Bill Kadereit: 6:26

Then it gets worse than that. Mike. These were just the retirees from IBM, at and t Avaya and the Tennessee Valley Authority.

Mike Roth ai: 6:35

So these are the big

Bill Kadereit: 6:36

four.

Mike Roth ai: 6:36

The big four groups that we know about.

Bill Kadereit: 6:38

Two of them are small. Two of them are very large.

Mike Roth ai: 6:41

Okay.

Bill Kadereit: 6:41

But there are thousands of others that, that we were not in this study because it did not come to our attention. We actually surveyed the retirees that were re in this con comp, these companies that we could reach by using our website and the members we have and being able to contact them by email, it's the only way we could collect the data. And so it's so important that people sign up and help us understand the magnitude of the problem.

Mike Roth ai: 7:09

So this year, if you get a cancellation letter.

Bill Kadereit: 7:12

Right?

Mike Roth ai: 7:13

You should immediately join and let us know that you were canceled.

Bill Kadereit: 7:16

Go to nr n.org on the website. There are contact. You can email to us, you can call us and make us aware. We had a hundred or so people actually send copies of insurance company documents. The reason that's important is because if they send me a document and it says, blue Cross and Blue Shield is doing this in Michigan, in this county, chances are it's doing it in other states as chances are us doing it in every county in the state. If United Healthcare people call, send me letters and say, I'm the, I didn't get a letter. Then chances are every, per, every state in the union is having that same problem. And then we go in and study it in depth. And that's where having all these members, all these people call and sign up and work with us on this issue first. All critical. Yeah.

Mike Roth ai: 8:02

Now, again, not everyone may have listened to the first five episodes this year. And they can easily go back to the nr. ln.org website and click the link to go back to episode number one or they can go back to the direct link. AREFpodcast dot. ORG. And there they can see a list of all the currently available episodes. If this is the first episode that you've listened to and how important is it for 'em, bill to go back and start listening at episode number one.

Bill Kadereit: 8:40

It lays a baseline for them. You get a lot of information about. Where healthcare benefits are going, the cost of them, how much where premiums and deductibles and everyone, everything else is going. And you can compare where you're at against that. And this podcast, for example, and this you'll know how many people are affected. And when you get that letter, we hope you'll understand that it's more important than maybe last time. And so what we're hoping to do is raise the information level so that you can don't, so you don't throw it away.'cause it's your golden ticket.

Mike Roth ai: 9:12

Yeah. You don't want to be taken advantage of.

Bill Kadereit: 9:15

That's

Mike Roth ai: 9:15

right. And we'd like everyone to be informed. That's why we're doing this series. Now let's talk about some of the payments that are made on be by Medicare bill.

Bill Kadereit: 9:26

Yeah. A surprise to a lot of people when you tell 'em this number, that only 25% of the people in Medicare submit claims that are paid by CMS, by the Medicare organization, and 85% of the money paid out by Medicare is paid to just that 20, 25%. That means that when you're, basically, if you'll think about that, it means that younger people in Medicare age 65 to say 75 don't consume near as much money because there aren't as many claims made by that group. Because when the serious as illness, serious catastrophic illnesses set in and they get worse over time, you spend a lot more money on healthcare. And that's where the insurance companies are starting to buckle their knees because the claims are starting to roll in because people have been in Medicare Advantage plans now for about 15 years, and that 65-year-old, 15 years ago is now 80. And maybe they've got arthritis. Maybe they have cancer or lung disease of something.

Mike Roth ai: 10:31

The odds

Bill Kadereit: 10:31

change. Oh my God. It's like the

Mike Roth ai: 10:33

odds change the older,

Bill Kadereit: 10:34

your gas. Oh my gosh, yes. Yeah. And it's very real. Yep.

Mike Roth ai: 10:37

Now, bill, why don't we talk or you talk, tell our listeners a little bit about what the penalties are for making false statements.

Bill Kadereit: 10:45

Controls over this whole process, and we're not gonna go through the details of the statutes with you, but fi primarily, if you are identified as eligible for A GIR it, the company managers who administer the plan are liable for sending you that note. If you are with the insurance company is liable for sending you that information if they mislead you and don't do that. They violate the minimums, federal standards, and if you willingly do that or make false statements about compliance, it carries up to a five year imprisonment and a civil fine of up to $5,000 per occurrence. So that 163,000 people, that was worth over a billion dollars. In lost earnings, and so it was very significant. We think the federal government needs to enforce the law. The minimum standards, whole purpose of this discussion on this issue is that there are rules in place that say you can't do it, and if you don't do it, you can be fined. You're put in prison.

Mike Roth ai: 11:47

So last year, bill, how many people were put in prison or fined?

Bill Kadereit: 11:51

None.

Mike Roth ai: 11:52

Gee, there's no enforcement then who's responsible for enforcing it? Bill?

Bill Kadereit: 11:56

It's confusing, but I, we know where we're going with this. When we first started with the Tennessee Valley case, we went to the state of Tennessee. And the state of Tennessee said, oh, this is not our problem. It's a federal problem. So we went to the federal agency, CMS, I mentioned the acronym earlier, and they said, oh, this is not a federal problem. This is a state problem. So I went back to the state. The state guy says, no, you didn't hear me the first time. This is a federal problem. He said, but if they send me the money. I'll hire people and enforce the rules. In fact, the federal standards are federal minimum standards. The states can implement more stringent standards, but they have to implement the minimum standards. So if the states won't do it, and CMS won't force them to do it. Now, CMS has been cooperative. Last year we got them to send letters out to every insurance company. With model letters of what they should send people by plan type, Medigap plan, Medicare Advantage plan, prescription drug plan. And they did send them out, but we got the same results. The insurance companies just thumbed their nose at 'em. So this year our propo is gonna be go to the attorney general's office and say, okay, buddy you're the chief guy in charge of law here. Who is responsible, who's culpable? For implementing and enforcing these laws because people are gonna lose a lot of money when they have to pay these bills when they're uninsured because you, they in inter terminated their plans or non-renewed them. That's what this federal statute is clearly all about.

Mike Roth ai: 13:26

Okay. Is the federal statute about SEP and. GIR?

Bill Kadereit: 13:32

Yeah. SEP is the supplemental enrollment period. Because once you're protected, then you have a supplemental period in which you have to then go make your choice Okay. To replace your product. And so they're hand in hand? Yeah.

Mike Roth ai: 13:47

Okay.

Bill Kadereit: 13:47

And that and there's a whole list of detailed minimum standards in the statute. I don't think it would be much good to go through every one of them, but let me just cite virtually the elements of each. The first one is they have to identify you. They have to notify you. They have to give you an opportunity to find the best plan in the marketplace that you can find. They cannot, that you cannot be charged more than anyone else out there buying the same plan, even though you have restrictive commission healthcare problems.

Mike Roth ai: 14:23

So the health, your condition of health is not part of the determination of the price you pay if you are. Involved in one of these terminations where you have a guaranteed right of issue.

Bill Kadereit: 14:37

If you have the guaranteed right because of a termination in a non-renewal, you have a right to buy another Medigap plan, let's say, or you have and you can borrow by a Medicare Advantage plan,

Mike Roth ai: 14:49

but it is not re, the pricing of that plan is not relative to your current health.

Bill Kadereit: 14:55

Absolutely. You cannot be rejected because of a health condition.

Mike Roth ai: 14:59

So it's like you were 65 again.

Bill Kadereit: 15:01

That's right.

Mike Roth ai: 15:01

And you were perfectly healthy.

Bill Kadereit: 15:03

Yep.

Mike Roth ai: 15:04

So that's why we're calling it a golden ticket.

Bill Kadereit: 15:06

And think about why you've paid that insurance company all these years from age 65 to maybe 80 or 85, and now they walk away from you. And they leave you without insurance. Like I said, they don't have to file for bankruptcy. They just walk away from you. They can turn, I'm not making money on a plan in this county, drop it. I'll go over here where I can make some money. And that's exactly how they operate. They're like banks. They are, they just have more lawyers and actuaries than banks do.

Mike Roth ai: 15:36

So this, is this applicable only to individuals or is it. Also true for people who were part of a company plan.

Bill Kadereit: 15:46

It's applicable for both. In a company plan, the person who should advise you is the plan administrator for the company. And there's one designated for each healthcare plan. Companies have administrators. On the other hand, if you have an individual plan with a private insurance company on your own and your company's not involved, then it's between you and the company.

Mike Roth ai: 16:10

Okay?

Bill Kadereit: 16:10

Yep.

Mike Roth ai: 16:11

What are the enforcements standards?

Bill Kadereit: 16:13

The enforcement standards? Yeah. As I mentioned earlier, the minimum standards are there 10 specific. Items under the minimum standards under the Model six 50 rules of the NIC, which is the state regulatory regulations also. So the state regulations pretty much mirror the federal standard. The problem is they all ignore it. The, the insurance companies don't want any problems. They walk away from it. The states don't want any problem to deal with it, and the CMS is afraid to do anything because of the politics.

Mike Roth ai: 16:46

If everyone's afraid to do anything.

Bill Kadereit: 16:49

Yeah.

Mike Roth ai: 16:49

How does an individual protect themselves?

Bill Kadereit: 16:52

We would hope to get a lot more support from people.

Mike Roth ai: 16:55

Sounds almost like there's enough. It could be enough people involved to get a class action lawsuit.

Bill Kadereit: 17:00

They're begging for a class action lawsuit for sure. And that might wake up the federal government, but then the lawyers get involved and it'll take years to settle. The problem with litigation is

Mike Roth ai: 17:13

takes too much time.

Bill Kadereit: 17:13

Yeah. It's like kicking the dinosaur and the tail and five years later the head turns, it's, that's a litigation does for you.

Mike Roth ai: 17:19

Okay. Why don't you remind our listeners what happened to at t and. IBM employees retirees from 2023 to 2024.

Bill Kadereit: 17:29

Yeah. First of all, IBM privatized or had a pension risk transfer on its pensions, I think in 22 or 23. They also in informed. All their retirees who had Medigap plans that they would lemme back up a second. The way they handle their plans in IBM and at and t and a lot of other companies is you have a, an account. And it's usually. A reimbursement account, HRA health reimbursement

Mike Roth ai: 17:58

account.

Bill Kadereit: 17:59

And that means you pay for it and then you go to the company and they reimburse you IBM's people who had Medigap plans were doing that. So maybe they were paying$180 a month for themselves and 180 for their wives, and the benefit was about $300 a month for every person. And they, the money was paid through this account. IBM. Had, I had UnitedHealthcare come in and replace their current Medicare Advantage plans with new Medicare PPO plans and they told their retirees, you can take your money from your HRA account. It is notional money because there's no cash there. We just pay on reimbursement basis. You can take that amount of credits. And apply it to a Medicare advantage plan that United Healthcare is offering.

Mike Roth ai: 18:45

Okay.

Bill Kadereit: 18:46

But if you want to continue paying for your Medicare, your Medigap plan you have to pay it out of your own pocket. And so that's a plan termination. You can call it whatever you want. They basically. Took the money away from people so they couldn't possibly afford the plan. And so that was the plan termination. That effect on that was o over a hundred thousand people. Okay. And at and t did the same thing. The only difference is at and t did it over two years. IBM did it in one year, 2023.

Mike Roth ai: 19:17

Now, was that legal?

Bill Kadereit: 19:19

No, in my opinion I wrote, personally signed the letter along with the president of the chap, the organizations from retiree organizations from both IBM and at to at and t, and I wrote a letter to the CEOs of both companies. And I asked him, why did you do this? I said, you were able to cancel the benefit. You benefited it from it financially. And you won't even help your retirees get a better deal outside the company. I said that's stupid. So anyhow

Mike Roth ai: 19:51

did you get any answer?

Bill Kadereit: 19:52

Typically no response.

Mike Roth ai: 19:53

So what is the solution?

Bill Kadereit: 19:55

The federal courts have the responsibility for doing that. There's a federal minimum standards, and it's so clear that they have the obligation to do it.

Mike Roth ai: 20:05

Okay.

Bill Kadereit: 20:05

It federal, it's a federal problem.

Mike Roth ai: 20:07

And tell us what the Affordable Care Act of 2010 says about this.

Bill Kadereit: 20:15

Nothing

Mike Roth ai: 20:16

Tell us about the Federal.

Bill Kadereit: 20:17

Here's the differentiator here. When the Affordable Care Act of 2010 was passed, it was legislated to include guarantee issue, rights. For anyone under age 65 who would participate in this new nationwide plan that would, where plans would be sold through what are called private medical enrollees these agencies, then. Were to reach out and cover more people. and give them guarantee rights, should their plans be canceled. But the law didn't apply to anybody over age 65. The insurance companies negotiated behind the scenes with the government when they cut the deal and they said, we're not going to guarantee issue rights for older people because it'll cost us too much. We'll go out. We we're not gonna, we don't wanna honor their. Guarantee issue rights because it's our practice to just walk away from them. When we turn away, turn terminate plans.

Mike Roth ai: 21:10

What is the trial right all about?

Bill Kadereit: 21:13

There is a 12 month trial right. In which time you can have a right to switch back. Into Medigap or any other plan

Mike Roth ai: 21:21

into traditional Medicare.

Bill Kadereit: 21:22

That's right. And our, in our proposal is that guarantee issue right, should be extended for 12 months. They should have a guarantee issue right after termination, not 60 or 90 days to find a new policy. So we're looking for an equality of GIR treatments there.

Mike Roth ai: 21:39

What is the NR bill? What is the NRLN doing? With the Secretary of Health and Human Services and the attorney General.

Bill Kadereit: 21:49

We haven't been to the Attorney General's office yet. That is the next step. I have a letter halfway prepared and we're going to do that. But we met with the CMS at their headquarters. They actually, their headquarters is actually in Baltimore. Quite a few people there, by the way. And we met with the leadership team.

Mike Roth ai: 22:06

Yes.

Bill Kadereit: 22:07

And they agreed that they would write letters. Two, the insurance companies advising them of the middle minimal standards and that they had to follow them, and they also sent with them model notices. Notifications. And there was a model notification for anybody that lost a Medicare advantage Plan, a model notification for anybody that lost a prescription drug Plan, a model notification for anyone that lost a Medigap plan. And they got all that out before the enrollment period. But all indicators are that old practices are crosswalk and all those other things are still going on out there.

Mike Roth ai: 22:49

So seniors listening to this broadcast, if you're canceled by your plan because they're no longer gonna be issuing in your area, know that you should be offered. These guaranteed rights of renewal at, at a point in time, which is when you were 65 and healthy.

Bill Kadereit: 23:09

If you have a plan, non-renewed, terminated, or you move to another state and you think, and you're eligible for a GIR based on what we just said. You can go on the website and read our case on this, and it's all there. Medicare nrln.org. Under legislative agenda and white papers, it's there for you to read everything that I've just said today. So yes, the important thing here is that if you don't get a letter or you get one that doesn't have a GIR in it, let us know. Go to the nrln.org. Email a copy to us. We don't want personal information, but we have to have your email address and we'll put it on our information site, our websites records, so we can contact you with any important notifications on healthcare and print pensions and whatever, but particularly on this case. And we'll get back to you with an answer. Good. And we'll use your letter. If it's applicable to this case, we'll pile 'em up if we have to and box 'em up and take them in there.

Mike Roth ai: 24:08

Good. And so I guess Bill, that brings us to the end of what we were gonna say about guaranteed issue rights.

Bill Kadereit: 24:13

Yes.

Mike Roth ai: 24:14

Okay. I want to thank everyone for listening. In two weeks we'll be back with a new episode. In the meantime, sit back and copy down the information on this information card that you're gonna see and enjoy the song. For seniors by NRLN

Bill Kadereit: 24:31

and seniors are special.

Mike Roth ai: 24:33

Seniors are special.