Medigap Haven

When selecting their coverage option, seniors deserve protection from discrimination based on factors out of their control. However, Medigap regulations vary across the Federal and State levels, especially between different states.

Guaranteed issue protections are requirements that a plan must enroll you regardless of current health status or other factors that “might predict the use of health services.” Under Federal law, seniors only have these protections during the initial 6 month period of Medicare Part B enrollment or during designated ‘trial periods.’ Outside of these specific times, seniors have no guaranteed issue protections. Additionally, the protections that are in place fail to address the variance that may occur with how much you will be charged during enrollment based on otherwise protected factors.

States have full autonomy to expand issue protections beyond Federal minimums. Unfortunately, very few do. And when they do, the protections are not blanketed. Some states offer protections from denial when switching to a Medigap plan from another type of plan (such as Medicare Advantage). Other states require Medigap plans to enroll qualifying patients during specified events after the initial enrollment period. But, only four states have annual or continuous guaranteed issue protections for all seniors (Connecticut, Maine, Massachusetts, and New York).

Denying Medigap coverage for otherwise eligible seniors based on their health should not be permitted, especially considering that’s when they need coverage the most. The protection model in the four blanket protection states should serve as a guide for other states as they look to improve protections for seniors.