3.2 Connecticut Medicare Supplement (Medigap) Regulations

Federal Floor: the 6-Month Open Enrollment Period

Medicare Supplement (Medigap) policies fill gaps in Original Medicare -- the Part A hospital deductible, Part B coinsurance, and similar cost sharing. Federal law gives every beneficiary a one-time 6-month Medigap Open Enrollment Period (OEP) that begins the first day of the month the person is both age 65 or older AND enrolled in Medicare Part B. During the OEP:

• The application is guaranteed issue -- no health underwriting.
• The carrier cannot charge more for health conditions.
• The applicant may choose any standardized plan A through N the carrier offers.

This 6-month federal window is the baseline in every state. Connecticut, however, adds two powerful protections that frequently appear on the state portion of the exam.

Connecticut's Continuous Guaranteed Issue

Unlike most states, Connecticut requires Medigap to be guaranteed issue year-round. A carrier offering Medigap in Connecticut must accept any eligible applicant at any time of year, for any reason, and cannot decline coverage because of a pre-existing condition. This means a 72-year-old who declined a plan at 65 can still buy one today on a guaranteed basis -- something residents of most states cannot do without underwriting.

Exam correction: Older study material claiming Connecticut "allows health underwriting outside the 6-month window" is wrong. Connecticut's continuous guaranteed-issue rule overrides that.

Community Rating (CGS Sec. 38a-473)

Connecticut also mandates community rating for Medigap. Premiums cannot vary by age, gender, or health status -- every person buying the same plan from the same carrier pays the same base rate. Contrast that with the three pricing methods used elsewhere:

Trap: because Connecticut is community-rated, "the premium will increase each year as the insured ages" is a false statement on the exam -- rates change only by approved class-wide filings, not by birthday.

Standardized Plans A Through N

Medigap plans are federally standardized, so a "Plan G" delivers identical core benefits no matter the carrier; only price and service differ. Connecticut adopts these standards.

Key date: anyone who became eligible for Medicare on or after January 1, 2020 cannot buy Plan C or Plan F, because those plans pay the Part B deductible and the MACRA reform barred new "first-dollar" coverage. Beneficiaries already enrolled in C or F may keep them. For new enrollees, Plan G is the closest comprehensive substitute.

Pre-Existing Conditions and Switching Plans

Even with continuous guaranteed issue, a Medigap insurer may impose a pre-existing condition waiting period of up to 6 months -- but only if the applicant did not have 6 months of continuous creditable coverage before applying. A beneficiary moving directly from an employer group plan or another Medigap policy typically satisfies the creditable-coverage test, so no waiting period applies.

Federal Guaranteed-Issue Triggers (Still Relevant)

Federal law lists situations that create guaranteed-issue rights everywhere. They matter less in Connecticut (which already guarantees issue year-round) but still appear on the exam:

• The insured loses employer group retiree coverage.
• The insured disenrolls from a Medicare Advantage plan within the trial-right window.
• A Medicare Advantage plan leaves the service area or stops serving Medicare.
• The insured's Medigap carrier becomes insolvent or ends coverage through no fault of the insured.

Worked example: A Connecticut man turned 65 and enrolled in Part B two years ago but skipped Medigap. He now wants Plan G after a cancer diagnosis. In a typical state he could be declined or surcharged; in Connecticut the carrier must issue Plan G on a guaranteed basis at the community rate -- though a 6-month pre-existing waiting period could apply if he lacked prior creditable coverage.

Medigap vs. Medicare Advantage -- Don't Confuse Them

The exam routinely tests whether a candidate can separate the two ways to round out Medicare. They are mutually exclusive: a beneficiary cannot legally hold a Medigap policy and a Medicare Advantage plan at the same time.

Selling rule: a producer who replaces a Medigap policy must complete a replacement form, compare benefits, and avoid leaving the client with overlapping or duplicate coverage. Suggesting a senior buy a second Medigap policy is an unfair practice -- one Medigap policy supplements one beneficiary.