Regulation of Medigap – Federal and State Level Coordination

While some regulation comes from the federal level, Medicare Supplements are mainly regulated at the state level.

This is why you may see differences in Medicare Supplements from state to state.

Here we want to review some of the specific state rules you may come across.

The first difference on our list? Those states that DO NOT use the standardized model: Massachusetts, Minnesota, and Wisconsin.

These plans are each a little different.

Massachusetts, for example, offers three distinct Medicare Supplement Plans, where Wisconsin offers a base plan with riders that can be added.

The next difference is that some states require community-rated premiums.

As we talked about earlier, this means that Medicare Supplement plans in these states must charge the same premium to all members of that plan, regardless of age.

Another difference; certain states will allow additional opportunities to change plans.

For example, a birthday rule exists in a few states to give current Medicare Supplement beneficiaries an annual opportunity to switch to another Medicare Supplement plan.

Similarly, some states, like New York, offer continuous open enrollment, so that beneficiaries can apply for a Medicare Supplement at any time without being denied coverage based on their health.

The final difference on our list is how states regulate Medicare Supplements for Medicare beneficiaries under age 65.

Some states require carriers to offer one or more Medicare Supplements for those on Medicare due to a disability.

To better understand your state’s specific rules on Medicare Supplements, we recommend checking out your State Department of Insurance website.

Watch the Next Lesson