Looking for a Medigap Policy? Know Your State’s Rules

United states next to road sign reading open enrollment ahead

The Kaiser Family Foundation has released new research which analyzes Medigap availability and enrollment across the United States. Medigap is insurance sold by private insurance companies which supplements your existing Original Medicare (Part A and Part B) coverage. Here are 10 facts and figures about Medigap, and ways your Medigap policy might vary based on the state in which you live. 

  1. Enrollment numbers. As of 2015, one in four people enrolled in Original Medicare also has a Medigap policy.
  2. Enrollment by state. Medigap enrollment varies widely among states. Hawaii has a Medigap enrollment of 3 percent while 51 percent of people with Original Medicare in Kentucky also have a Medigap policy.
  3. When to enroll. Medigap does not have an annual enrollment period (yet), meaning you’ll have to enroll during your initial enrollment period (IEP) or miss your chance. Your IEP is the three months leading up to your 65th birthday, your birthday month, and the following three months.
  4. Pre-existing conditions. If you have a pre-existing condition, you could be denied Medigap coverage. This denial could happen if you have Medicare Advantage and want to switch to Original Medicare plus Medigap.
  5. Rising premiums. Policymakers fear the expansion of guaranteed issue protections will make people wait until they develop a serious medical condition to buy a Medigap policy, which would raise premiums.
  6. Medical history protection. Only 4 states require protections for all beneficiaries regardless of medical history: Connecticut, Massachusetts, Maine, and New York.
  7. The birthday rule. In California and Oregon, a “birthday rule” allows you to enroll in a Medigap policy or switch plans for the same or lesser benefits within 30 days of your birthday each year.
  8. The anniversary rule. In Missouri, you have a 60-day window around the anniversary of buying your Medigap policy in which you can switch to the same plan from another carrier.
  9. Medigap and disabilities. If you have Medicare due to a disability, your opportunity to purchase a Medigap policy depends on the regulations set by the state in which you reside.
  10. Standard plans. Medigap plans are standard across states, meaning a plan you buy in Florida will be the same as a plan you buy in Tennessee. However, premiums do vary based on location.

Related articles:

Medicare Advantage vs Medigap

5 Things to Know about Medigap

Pre-Existing Conditions and Medigap

How to Save on Out-of-Pocket Medicare Costs with Medigap

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