Many states have established regulations to simplify the process for seniors to modify their Medigap plans. In the following sections, we will outline the specific Medigap regulations and the states where they apply.
Which States Have Medigap Birthday Rules?
California and Oregon have implemented a birthday rule that allows their Medigap policyholders to review and change their coverage annually. In California, the rule is applicable to all residents with a Medigap policy and provides a 30-day window before their birthday and a 60-day window after to switch to a plan of equal or lesser benefit with any carrier, without the need to answer health questions. Similarly, the Oregon birthday rule also permits policyholders to switch to any carrier or plan of equal or lesser benefit within a 31-day period starting on their birthday, without any health underwriting. However, unlike California’s rule, the Oregon birthday rule only applies during this specific time frame.
California and Oregon were the original states to implement the Medicare Supplement birthday rule, and now Idaho, Illinois, Louisiana, and Nevada have followed suit, bringing the total number of states with this rule to six. However, the specifics of the rule vary by state. In Idaho, Medigap policyholders have a 63-day window beginning on their birthday to enroll in a plan of equal or lesser benefit with any carrier. Illinois’ rule applies only to beneficiaries aged 65-75, who have a 45-day enrollment window starting on their birthday to switch to a plan of equal or lesser benefit from their current carrier. Louisiana’s window opens 30 days before the beneficiary’s birthday and lasts 63 days after, allowing for a 93-day period to switch to a policy of equal or lesser benefit through the current carrier. In Nevada, the enrollment period lasts for at least 61 days, starting on the first day of the beneficiary’s birth month, during which policyholders can switch their Medigap carrier or plan to one of the equal or lesser benefit levels.
Which States have Anniversary Rules and Guaranteed Issues for Their Medigap Policies?
So, guaranteed issue rights allow beneficiaries to purchase a policy without medical underwriting, This means that, in certain cases, insurers can deny your coverage based on pre-existing conditions. They are, in fact, obligated to give you a policy if you have guaranteed issue rights. This right is usually applied during the Medigap Open Enrollment period when you are both enrolled in Medicare and your Part B effective date has started, so you are able to purchase a Medigap policy. If you do it during this 6-month window your application can’t be denied.
However, if you miss this period you may purchase a policy, but your coverage can be denied if your health status isn’t good.
However, some states have rules in which you can use your guaranteed issue rights once more. For example, in the state of Missouri, there is an Anniversary rule which allows beneficiaries to switch their companies between the same plans 30 days before their anniversary Mdeedigap enrollment date starts end ends 30 days after. This allows you to compare your plan and prices annually between different insurance companies and switch without medical underwriting.
For example, in Washington guaranteed issue rights allow beneficiaries to change their plans with equal or lesser benefit at any time in 365 day period (year-round).
Remember that plans C or F is no longer available to new Medicare beneficiaries. For more information, check what are the limitations of the Anniversary rule in Missouri.
States with Open Enrollment For Medigap All Plans
New York, Connecticut, and Vermont have a year-round open enrollment for all supplement plans. However, Vermont only allows Medigap plans from Omaha and UnitedHealthcare.
Maine on the other hand allows an Open Enrollment period in June for plans with equal or lesser benefits.
States With Different Rules For Medigap Policies
Three states that have different rules for their Medicare Supplement plans are Massachusetts, Minnesota, and Wisconsin.
Massachusetts offers only three Medigap policies which are called Core Plan, Supplement 1A plan, and Supplement 1 Plan.
The core plan offers the basic benefits whilst Supplement 1 Plan is the most comprehensive plan you can purchase. Because this plan is similar to Medigap Plan F you can’t purchase this plan if you weren’t eligible for Medicare coverage prior to 1st January 2020.
Minnesota offers only Medigap plans, which are called Basic Plan and Basic Extended Plan. With these plans, you can add riders to your policy if you want to extend your coverage. These additional benefits will include coverage for Medicare Part A hospital deductible, Medicare Part B deductible (if you were eligible before the 1st of January 2020), usual customary fees, and non-Medicare preventive care.
Wisconsin offers only one Medigap supplement plan which is called the Basic Medicare Supplement plan. These plans may include extra benefits like 25% or 50% of cost-sharing, high deductible plan, Medicare Part A hospital deductible coverage, extra home health care visits, Medicare Part B excess charges, Foreign travel emergency, Part B coinsurance, and Medicare Part B deductible (no for new Medicare beneficiaries).
However, all of these plans cover the set of basic benefits like Medicare Part A coinsurance plus additional 365 days of hospital stay after Medicare coverage benefits are exhausted, Medicare Part B coinsurance which is typically 20% out-of-pocket cost for medical services, and three first prints of blood for medical procedures.
Additional benefits will vary on which plan you choose if you live in one of these three states which have their policies differently arranged than in other federal states. Most other states have 10 standardized plans lettered from A to N. This means that in each of the 47 states, all the plan letters offer the same set of benefits.
For example, Plan A in New York and Missouri must offer the same set of benefits under this letter. The same thing is for all other states except those three mentioned before.
So, if you purchase Plan G in Chicago and your friend lives in Missouri and purchase plan G you and your friend will have the same set of benefits.