Key Takeaways
- Arizona provides a 6-month open enrollment period for Medicare Supplement starting at age 65 with Part B
- During open enrollment, insurers cannot deny coverage or charge more due to health conditions
- Arizona does NOT have a Birthday Rule like California for annual Medigap switching
- Guaranteed issue rights apply when losing other coverage or in specific circumstances
- Medicare Supplement plans must be standardized using letter designations (A through N)
Arizona Medicare Supplement (Medigap) Regulations
Arizona has adopted federal Medicare Supplement (Medigap) regulations with standard protections for Medicare beneficiaries.
Open Enrollment Period
Arizona provides a 6-month open enrollment period for Medicare Supplement:
When It Begins
The 6-month period starts:
- First day of the month you are 65 or older AND
- Enrolled in Medicare Part B
Protections During Open Enrollment
- Guaranteed issue - Must be accepted regardless of health
- No pre-existing condition exclusions can apply
- Standard rates - Cannot be charged more for health conditions
- Any plan available - Can choose any Medigap plan offered
Exam Tip: The 6-month open enrollment period is a federal requirement that Arizona follows. This is the best time to purchase Medigap coverage.
Guaranteed Issue Rights
Beyond open enrollment, Arizona provides guaranteed issue rights in specific situations:
Triggering Events
| Event | Guaranteed Issue Right |
|---|---|
| Losing employer coverage | Can purchase Medigap within 63 days |
| Leaving Medicare Advantage | Can return to Medigap within 63 days (conditions apply) |
| Medicare Advantage plan leaves area | Can purchase Medigap |
| Medigap insurer becomes insolvent | Can switch to comparable plan |
| Losing Medicaid | Can purchase Medigap |
| Losing retiree coverage | Can purchase Medigap within 63 days |
Trial Right
If you leave Medigap for Medicare Advantage for the first time:
- Have 12 months to decide
- Can return to previous Medigap plan
- Or any plan from same insurer
- Guaranteed issue, no health questions
No Birthday Rule
Unlike some states (like California), Arizona does NOT have a Birthday Rule:
What This Means
- Cannot switch Medigap plans annually without underwriting
- After open enrollment, health questions may apply
- Premium may be higher based on health conditions
- Best to choose right plan during open enrollment
Switching Plans After Open Enrollment
If you want to switch Medigap plans after open enrollment:
- May be subject to medical underwriting
- May be denied based on health conditions
- May face higher premiums
- Exception: Guaranteed issue situations apply
Standardized Plans
Arizona requires Medigap plans to be standardized:
Available Plans
| Plan | Benefits |
|---|---|
| Plan A | Basic benefits only |
| Plan B | Basic + Part A deductible |
| Plan C | Comprehensive (pre-2020 only) |
| Plan D | Similar to C, no Part B excess |
| Plan F | Most comprehensive (pre-2020 only) |
| Plan G | Like F without Part B deductible |
| Plan K | 50% cost sharing, out-of-pocket max |
| Plan L | 75% cost sharing, out-of-pocket max |
| Plan M | 50% Part A deductible |
| Plan N | Cost sharing, copays for visits |
Note: Plans C and F are only available to those eligible for Medicare before January 1, 2020.
Rate Regulation
Arizona allows different rating methods for Medigap:
| Rating Method | Description |
|---|---|
| Attained Age | Premiums increase with age |
| Issue Age | Premium based on age at purchase |
| Community Rating | Same rate regardless of age |
Most Arizona insurers use attained age rating, meaning premiums increase as you get older.
Pre-Existing Condition Provisions
During open enrollment:
- No pre-existing condition exclusions allowed
Outside open enrollment:
- Insurers may impose up to 6-month waiting period for pre-existing conditions
- Applies only to conditions treated within 6 months before coverage
- Prior creditable coverage may reduce or eliminate waiting period
How long is the open enrollment period for Medicare Supplement in Arizona?
Does Arizona have a Birthday Rule that allows annual Medigap plan switching without underwriting?