3.2 Colorado Medicare Supplement (Medigap) Regulations

Medicare supplement (Medigap) insurance fills gaps in Original Medicare—deductibles, coinsurance, and copays. Colorado follows the federal standardization scheme while applying its own consumer-protection and enforcement layer. Several numbers in this section are heavily tested.

Open Enrollment Period (6 Months)

Every Medigap applicant gets a one-time 6-month open-enrollment period:

• It begins on the first day of the month in which the person is both age 65 or older AND enrolled in Medicare Part B.
• During this window the applicant has guaranteed-issue rights: the insurer must sell any Medigap plan it offers, cannot medically underwrite, cannot charge more for health conditions, and cannot impose pre-existing condition waiting periods (when the applicant had prior creditable coverage).

This 6-month window is the single best time to buy Medigap. Once it closes, an insurer may use medical underwriting to accept, decline, or rate an applicant—unless a separate guaranteed-issue right applies.

Exam Tip: The trigger is 65 + Part B, and the length is 6 months. A common distractor pairs the right length with the wrong trigger (e.g., "starts at Part A enrollment")—the controlling enrollment is Part B.

30-Day Free Look

Medicare supplement policies include a 30-day free-look period. The buyer may return the policy within 30 days of delivery for any reason and receive a full refund of premium. When switching from one Medigap policy to another, the beneficiary may briefly pay two premiums but can cancel the new policy within the 30 days if dissatisfied.

Exam Tip: Medigap's free look is 30 days—longer than the 10-day individual-health free look. Don't carry the 10-day number over to Medicare supplement questions.

Guaranteed-Issue Triggering Events

Outside open enrollment, federal law (followed in Colorado) grants guaranteed-issue rights after certain events. Generally the beneficiary must act within 63 days of losing the other coverage:

Medicare Advantage trial right

A beneficiary who dropped Medigap to try Medicare Advantage for the first time has a 12-month trial right: they may return to their prior Medigap plan (or a comparable one) on a guaranteed-issue basis within that year. This is a frequently tested protection.

Standardized Plans

Medigap plans are standardized by federal letter, so a "Plan G" provides the same core benefits at every insurer—only price and service differ. Colorado requires insurers to sell these standardized plans:

Note: Plans C and F cover the Part B deductible, which is why the MACRA change closed them to people who first became eligible for Medicare on or after January 1, 2020. Someone eligible before that date may still buy C or F if available.

Marketing and Disclosure Rules

Colorado, following the NAIC Medicare supplement model, imposes consumer-protection rules on how Medigap is sold:

• Outline of Coverage must be delivered, summarizing benefits and limits in a standard format.
• A Medicare supplement buyer's guide must be provided.
• Replacement of an existing Medigap policy requires a replacement notice and a determination that the new policy is in the consumer's interest—producers must not encourage a beneficiary to drop coverage that is better or to buy duplicate coverage.
• Selling a beneficiary a policy that duplicates coverage they already have is a prohibited practice.
• High-pressure tactics, misrepresentation, and cold-lead advertising practices are restricted.

Why these rules matter

Medigap buyers are seniors who may face aggressive sales tactics. The combination of the 6-month guaranteed-issue window, the 30-day free look, standardized plans that make comparison easy, and strict anti-duplication rules gives Colorado beneficiaries strong protection.

Exam Tip: Lock in three numbers for Medigap—6-month open enrollment (65 + Part B), 30-day free look, and the 63-day window for guaranteed-issue triggering events—plus the rule that C and F are closed to those newly Medicare-eligible after January 1, 2020.

Medigap vs. Medicare Advantage, and the Look-Back

A Medigap policy supplements Original Medicare (Parts A and B), letting the beneficiary use any provider that accepts Medicare while the policy pays Medicare's deductibles and coinsurance; a Medicare Advantage (Part C) plan is a network-based alternative that replaces how Original Medicare is delivered and often bundles drug coverage. Selling a Medigap policy to someone enrolled in Medicare Advantage, where it would pay little, can constitute unnecessary or duplicate coverage, a prohibited practice.

On pre-existing conditions: during the 6-month open-enrollment window an insurer cannot refuse coverage, but it may apply a pre-existing condition exclusion of up to 6 months for conditions treated in the 6 months before the policy started—prior creditable coverage offsets that waiting period day-for-day. Advising a client to enroll during open enrollment and keep continuous coverage neutralizes the exclusion.

Exam Tip: Two different 'six-month' figures appear here—the open-enrollment length and the maximum pre-existing exclusion. Prior creditable coverage shortens the latter.