Even though Medicare is a Federal program, some states have different terms for Open Enrollment, Guaranteed Issue Rights, excess charges, disability, etc. Below, we’ll highlight what states have their own unique guidelines.
Some states allow the “Birthday Rule,” which allows a 30-day timeframe for you to change your Medigap plan after your birthday every year. Also, you can change plans without underwriting as long as the policy benefits are equal to or less than your current plan.
The “anniversary rule” allows you to change plans within 60 days of your Initial Enrollment anniversary in a Medigap policy.
Here are some states with specific rules:
California – California Medigap rules abide by the birthday rule. The birthday rule in California allows you to change policies within a 60-day window. The birthday rule begins 30 days before your birthday and ends 30 days after.
Oregon – The birthday rule also applies to the state of Oregon.
Connecticut – Connecticut is a guaranteed year-round state, permitting you to make changes to your policy throughout the year.
Maine – Those in Maine have an extension on the standard Medicare Advantage “trial right.” In other states, you have only one year to switch to a supplement when you try an Advantage plan. But, in Maine, you can “try” the Advantage plan for three years, and you have 90 days after dropping the policy to switch to a supplement with Guaranteed Issue rights.
Vermont – In Vermont, you can enroll in a Medigap plan without underwriting throughout the year.
Also, you may need Medicare documents for Guarantee Issue rights. However, documents might not be necessary for Medigap Open Enrollment Period rights.
Guaranteed Issue States for Medicare Supplements
There are several differences between Open Enrollment vs. Guarantee Issue rights; mostly, during Open Enrollment, you have more plan options.
These States Offer Guaranteed Issue rights ANNUALLY:
Missouri – If you have a Medigap policy, you can switch plans within 60 days of your enrollment anniversary.
New York – You can enroll in a Medigap policy without underwriting throughout the year.
Washington – Allows Medigap enrollees to change Medigap plans (except for Plan A) at any point.
What States Do Not Allow Medicare Excess Charges
If you’re looking at purchasing a Medigap policy, you may find that some of the plans cover excess charges. When a doctor doesn’t accept Medicare, excess charges may occur; doctors can only charge 15% above the threshold.
State Specific Guidelines for Voluntary Group Termination
Voluntary group termination means you decide to end your group insurance plan. Sometimes, people pay more for their group insurance than they would pay for Medicare. If this is your current situation, group termination may be beneficial to your pocketbook.
Generally, choosing to leave your healthcare coverage will not land you in a Guaranteed Issue situation. However, there may be exceptions to the rule.
If the Employer-Sponsored Plan is Primary to Medicare
Many states within the U.S. have Guaranteed Issue rights for voluntary group termination. There are typically concrete terms in which you can take advantage of this process, however. If your employer’s health care policy is the primary form of insurance, and Medicare is secondary.
Below are the states in which the employer plan IS PRIMARY:
States that Offer Under 65 Plans for those on Disability
You may have Medicare coverage before turning 65 due to a disability or ESRD. If you have Medicare because of a disability or ESRD, you may not be able to buy the policy you’d like until you turn 65.
Federal law doesn’t require carriers to sell Medigap to people under 65. Still, some states require companies to sell Medigap, even if under 65. States that don’t require under 65 Medigap plans, may still have some options.
These states DON’T require Medigap options for those under 65:
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