New Medicare Supplement Open Enrollment FAQs
This change was initiated to provide consumer protection to a large class of Medicare Supplement policyholders that have or may become trapped in closed blocks of Medicare Supplement plans. Since the enactment of federal rules (MACRA – Medicare Access and Chip Reauthorization Act of 2015) certain Medicare Supplement risk pools, specifically Plans C and F, are generally closed to new enrollees. The policyholders in these closed blocks cannot transfer to more affordable plans without going through medical underwriting.
This same issue impacts other Medicare supplement consumers who, after their initial six-month Open Enrollment Period, are helpless to control the rising premiums for their Medicare supplement policies. Over time, these pools demand higher and higher premiums, and the insured, unable to transfer to a different plan because of medical conditions, is forced to pay the higher premium levels each year.
The rule changes made to OAC 365:10-5-129 allow the policyholder to move away from this situation and enroll in a lesser or equal Medicare Supplement plan for less premium. Oklahoma is one of eight (8) states that have adopted such open enrollment changes, often referred to as the Birthday Rule, to provide a level of equity and protection for policyholders and increase competition among carriers.
Yes. In addition to Oklahoma, there are seven (7) other states that have adopted the Birthday rule: California, Idaho, Illinois, Louisiana, Maryland, Nevada, and Oregon. Seven (7) additional states provide similar open enrollment rights and protections at least once per year to change to a different Medicare supplement plan: Connecticut, Maine, Massachusetts, Missouri, New York, Rhode Island, and Washington. Each of these states have differing rules regarding open enrollment.
Under the rule changes made to OAC 365:10-5-129, a policyholder who is currently enrolled in a Medicare supplement policy with no gap in coverage greater than ninety (90) days has the opportunity to switch to a different Medicare supplement policy of equal or lesser benefits with the same or different carrier. While the rule provides flexibility, issuers shall, at the very least, offer an annual sixty-day (60-day) open enrollment period beginning on the policyholder’s birthday. The birthday would be the first day of the sixty-day (60-day) period. This change applies to all Medicare supplement policies offered in the State of Oklahoma.
There could be another Medicare supplement plan available now through another carrier that provides you with the same coverage for a better price. With Medicare supplement policies, if Medicare pays on a claim, the Medicare supplement must pay so long as it’s one of the benefits included in that standardized plan. They cannot deny it for more information or for being out of network, etc. All carriers that offer Medicare supplement plans in Oklahoma are regulated by the Oklahoma Insurance Department to ensure they are fulfilling their obligations to consumers. So, whether you are purchasing a policy from a highly recognized carrier or one that is not as familiar, you can be certain the standard benefits for all carriers will be the same under each standardized plan.
A copy of the rule changes can be found on the Oklahoma Insurance Department’s website at the following link: https://www.oid.ok.gov/wp-content/uploads/2022/11/Chapter-10-Permanent-Rule-Text_Final.pdf
During the newly created “Birthday Rule” period, 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-day (60-day) enrollment period beginning on the policyholder’s birthday.
The rule changes do not impact the Medicare Supplement Open Enrollment Period or existing guarantee issue opportunities available to consumers. Contact SHIP or a licensed agent for more information about your options.
No. The rule changes to OAC 365:10-5-129 only apply to Medicare supplement plans.
Yes. It does not matter which state you were living in when you initially purchased your policy. What matters is that you are currently a resident of Oklahoma and meet the eligibility requirements in OAC 365:10-5-129(f).
- First, make sure you don’t cancel your current coverage until you have secured your new policy so that there is no lapse in coverage. Although this change allows you to purchase a new policy so long as you did not go more than ninety (90) days without a Medicare supplement policy, it is probably a good idea to keep what you’ve got in case of an unforeseen health issue.
- Contact the Medicare Assistance Program at the Oklahoma Insurance Department for a comparison of the standardized plans for which you would be eligible and their estimated costs. Local licensed insurance agents are also a great resource for information. Agents typically work with several carriers to offer their products locally, but they may not work with every carrier.
- Review your options and, when you have decided, contact a licensed insurance agent to enroll in your policy.
A policyholder can apply to change to a Medicare supplement policy with greater benefits; however, the issuer would be allowed to require underwriting. The rule changes to OAC 365:10-5-129(f) only require continuity of coverage without underwriting when switching to plans with equal or lesser benefits.
No. You can still shop for a Medicare supplement policy, but you would be subject to medical underwriting unless you meet some other circumstance identified in OAC 365:10-5-129.1. You have an annual open enrollment period every year to switch to a different Medicare Advantage plan if you are interested in changing out of your current Plan.
These changes do not affect policyholders with Prescription Drug Plans unless they also have a Medicare Supplement policy.
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 Oklahoma Insurance Department for review. Factors that may affect premiums include your age when you took out the policy (if issue-age rated), your age each year (if attained-age rated), health conditions, and tobacco use.
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 open enrollment period under the Birthday Rule starting the day of your birthday.
Because you are currently in a Plan F, you would be eligible to switch to any available plan of equal or lesser benefits, including another plan F if one is available, from any carrier.
No. You may have other options if your employer sponsored plan ends or discontinues benefits. Contact your employer for further information about your options.
The “Birthday Rule” is based on your birthday. If your birthday occurred within that two-month (2-month) period, you would have sixty (60) days from your date of birth to purchase a Medigap policy of equal or lesser benefits, so long as you did not go more than ninety (90) days without your previous Medicare supplement policy. If more than ninety (90) days have passed since your previous Medicare supplement coverage, you will be required to go through the underwriting process.
OAC 365:10-5-129.l(b) provides details on this situation. Basically, you would need to disenroll from the MA plan and return to your original Medicare supplement plan within ninety (90) days. The changes to OAC 365:10-5-129 only apply to a policyholder who is currently enrolled in a Medicare supplement policy with no gap in coverage greater than ninety (90) days. Also, keep in mind that the Birthday Rule would still apply regarding the timeframe within which you could switch Medicare supplement plans.
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 you choose to enroll in a Medicare supplement plan that does not cover the Medicare Part B deductible and have not yet met the Part B deductible for that calendar year, you would be responsible for cost sharing related to the Part B deductible.
No. The rule changes create a new open enrollment period in which the application must be submitted. Typically, the industry standard is that the effective date of a new Medicare supplement policy begins on the first day of the month following acceptance of an application by the issuer.
Yes, the new open enrollment requirements apply to all Medicare supplement policyholders, including those younger than sixty-five (65) who are on Medicare due to disability. You can purchase a different Medicare supplement policy of equal or lesser value, which, in this case, would be another Plan A from any carrier offered in Oklahoma.
No. First, a standard Plan G would be considered a plan with greater benefits. You would be eligible to enroll in a plan of equal or lesser benefits. In addition, carriers are only required to offer one of the ten standardized plans to individuals who are on Medicare due to disability during their open enrollment period. Therefore, you would need to find a carrier that offers a Plan G high deductible Medicare supplement plan to individuals who are eligible for Medicare due to disability.
The Oklahoma Producer Licensing Act permits but does not require insurance companies to pay commissions to agents for the sale of Medicare Supplement policies. Oklahoma law does not set specific commission levels other than to prohibit frontloading. These are considered private contract arrangements between the carrier and the agent.
“Dead-pooling” refers to a carrier’s action where consumers are locked into their current plan while their insurance company offers a new plan to new consumers. The rule changes to OAC 365:10-5-129 provide consumers with the option to annually change their insurance plan, regardless of any health conditions, to a plan providing equal or lesser benefits.
Maybe. The deductible may restart with the purchase of the new plan. Policyholders should speak to the carrier or a licensed agent about deductibles before purchasing a new plan.
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 Oklahoma’s Medicare supplement rules.
Birthday Rule Plan Options Chart
|Plan A, B
|Plan A, B, C, D, K, L, M, N
|Plan A, B, D, K, L, M, N
|Plan F High Deductible (hd)
|Plan F hd, G hd
|Plan A, B, D, G, K, L, M, N, F hd, G hd
|Plan G High deductible (hd)
|Plan G hd
|Plan K, L
|Plan M, N