Recent Changes to Medicare Supplement Law and Rules

Senate Bill 1143, signed by Governor Little on April 22, 2021, revised key provisions of Medicare Supplement policy eligibility and rating. The Department has engaged in negotiated rulemaking regarding IDAPA 18.04.10 to implement the changes in the bill.

Community rating is a rating method for Medigap insurance that assigns a single rate to all ages and classes of individuals in the group, regardless of risk factors such as age or health.

It depends. While the birthday rule only applies to people with Medicare Supplement policies, there may be other guaranteed issue rights available for someone to purchase a policy without underwriting.

People eligible for Medicare for reasons other than age may be charged up to 150% more than people eligible for Medicare based on age. When beneficiaries reach age 65 their premium will be changed to the premium for those eligible for Medicare due to age.

The rule allows you to leave your policy and purchase a new policy of similar or lesser coverage. For example, if you have a Plan G, you may purchase a Plan G or any plan with fewer benefits. You cannot upgrade/increase benefits. You may purchase the new plan from any company offering policies in Idaho.

If you have a Medicare Supplement policy you do not need to do anything. Your policy is guaranteed renewable. Even if the plan is issue-age rated (most common rating in Idaho), you do not need to change plans and companies cannot force you to move to a community-rated policy. You do have the opportunity to review your coverage and purchase a new, community-rated plan without underwriting as part of the new guaranteed issue or “Birthday Rule.”

These changes do not affect current policyholders. Your policy is guaranteed renewable. Even if the plan is issue-age rated (most common rating in Idaho), you do not need to change plans and companies cannot force you to move to a community-rated policy. You do have the opportunity to review your coverage and purchase a new, community-rated plan without underwriting as part of the new guaranteed issue or “Birthday Rule.”

These changes do not affect people with Medicare Advantage plans.

Not because of this law change. Medicare Supplement policy premiums typically change annually due to the increasing cost of medical care, and that is expected to continue.

Companies submit their premium rates to the DOI for review. Factors that may affect premiums include your age when you took out the policy (if issue-age rated), health conditions, and tobacco use. Companies are not permitted to change premiums based on attained age.

During the new, guaranteed issue or “Birthday Rule,” you may choose similar or lesser coverage from the same company, or from another company without underwriting. The Birthday Rule gives current policyholders an annual, sixty-three day enrollment period beginning on the policyholder’s birthday.

These changes do not affect beneficiaries with Prescription Drug Plans, unless they also have a Medicare Supplement policy. If you have a Medicare Supplement policy you do have the opportunity to review your coverage and purchase a new, community-rated plan without underwriting as part of the new guaranteed issue or “Birthday Rule.”

Plan F will not go away for anyone eligible for Medicare before January 1, 2020. If you have a Plan F, you may purchase a Plan F or lesser coverage, such as Plan G or any other letter plan, during the annual guaranteed issue (“Birthday Rule”) starting the day of your birthday.

“Dead-pooling” refers to an unfair trade practice where consumers are locked into their current plan while their insurance company offers a new plan to new consumers. The law change provides consumers the option to annually change their insurance company, regardless of any health conditions.

Idaho Medicare Supplement rules permit insurance companies to pay commission to agents for the sale of Medicare Supplement policies. The rule ensures commissions are paid regardless of the age of the policyholder, guaranteed issue status of the policyholder, or any other such bases.

The rule changes do not impact the Medicare Supplement Open Enrollment Period or existing guaranteed issue opportunities available to consumers. Contact SHIBA or a licensed agent for more information about your options.

Yes, the new rule allows 63 days from the date of your birthday to purchase a new plan. For example, if your birthday is December 28, and you already have a Medigap plan, you would be eligible to purchase and enroll in a new plan effective March 1, 2022 because that is within 63-days of your birthday. Some companies may allow you to submit an application ahead of the 63-days, however companies are not required to accept an application or issue a plan outside of the 63-day guaranteed issue.

Yes, beginning March 1, 2022, they have an annual 63-day guaranteed issue starting the day of their birthday to purchase comparable or lesser coverage. There may be other opportunities to purchase a Medicare Supplement when moving to Idaho depending on the situation. For example, if you had a Medicare Advantage plan before you moved. Contact SHIBA or a licensed agent for more information about your options.

No, the Medicare Part B deductible is an annual, calendar year benefit under Medicare. Changing Medicare supplement policies does not impact meeting the Medicare Part B deductible. However, if the beneficiary chooses to enroll in a Medicare Supplement plan that does not cover the Medicare Part B deductible, and had not yet met the Part B deductible for that calendar year, the beneficiary would be responsible for cost sharing related to the Part B deductible.

Maybe. The deductible may restart with the purchase of the new plan. Policyholders should speak to the company or a licensed agent about deductibles before purchasing a new plan.

This type of discount is only permitted on plans issued before March 1, 2022. After that date this type of discount is not permitted on new policies.

No. You may have other options if your employer sponsored plan ends or discontinues benefits. Contact your employer for further information about your options.

Yes, you may enroll in a plan of similar or lesser significant benefits, regardless of innovative benefits. Innovative benefits are not considered significant benefits under Idaho’s Medigap rules.