Key Takeaways
- Indiana requires a 6-month open enrollment period for Medicare Supplement starting at age 65
- Guaranteed issue rights apply during open enrollment and specific triggering events
- Indiana prohibits pre-existing condition waiting periods during open enrollment
- Medicare Supplement plans must be standardized (Plans A through N)
- Insurers can use attained-age or issue-age rating in Indiana
Indiana Medicare Supplement (Medigap) Regulations
Indiana has adopted standard protections for Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance.
Open Enrollment Period
Indiana 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
- Standard rates - Cannot be charged more for health conditions
- Any plan available - Can choose any Medigap plan A through N
Exam Tip: The 6-month open enrollment period is critical - it's the only time guaranteed issue is automatically available to all eligible persons.
Guaranteed Issue Rights
Beyond open enrollment, Indiana 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 |
| Medicare Advantage plan leaves area | Can purchase Medigap |
| Medigap insurer becomes insolvent | Can switch to comparable plan |
| Losing Medicaid | Can purchase Medigap |
Trial Right
If you leave Medigap for Medicare Advantage:
- Have 12 months to decide
- Can return to previous Medigap plan
- Or any plan from same insurer
- Guaranteed issue, no health questions
Standardized Plans
Indiana 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
Indiana allows different rating methods for Medigap:
- Attained age rating permitted (premiums increase with age)
- Issue age rating also permitted
- Rate increases must be filed with IDOI
- Cannot discriminate based on health during open enrollment
Pre-Existing Condition Rules
Outside of open enrollment:
| Situation | Pre-Existing Waiting Period |
|---|---|
| Open Enrollment | No waiting period |
| Guaranteed Issue | No waiting period |
| Outside both | Up to 6 months may apply |
Insurers may impose up to a 6-month look-back period for pre-existing conditions, but:
- Cannot apply during open enrollment
- Cannot apply during guaranteed issue situations
- Prior creditable coverage reduces waiting period
How long is the open enrollment period for Medicare Supplement in Indiana?
When can an insurer impose a pre-existing condition waiting period for Medigap in Indiana?