3.2 Delaware Medicare Supplement (Medigap) Regulations

What Medigap Is and Why It Is Standardized

Medicare Supplement insurance (Medigap) pays the gaps in Original Medicare — the Part A hospital deductible, Part B coinsurance, and similar out-of-pocket amounts. Congress standardized Medigap so that a plan letter means the same benefits at every insurer: an Insurer X Plan G covers exactly what an Insurer Y Plan G covers. The only differences are price and service, which is the whole point of standardization — it lets buyers comparison-shop without parsing benefit fine print.

The 6-Month Open Enrollment Period

Delaware follows the federal 6-month Medigap open enrollment period (OEP). It begins on the first day of the month in which the applicant is both:

• Age 65 or older, and
• Enrolled in Medicare Part B.

During this one-time, six-month window the applicant has guaranteed issue:

• The insurer must accept the application regardless of health.
• It cannot impose a pre-existing condition waiting period (if the applicant had at least 6 months of prior creditable coverage; otherwise a look-back up to 6 months may apply, reduced by prior coverage).
• It cannot charge a higher premium for health status.

Worked example: Someone who turns 65 on June 12 and enrolls in Part B effective June 1 has an OEP running June 1 through November 30. If they instead delay Part B until age 67 because they kept employer coverage, the 6-month OEP does not begin until the Part B effective date at 67 — a frequent exam trap, because OEP is tied to Part B enrollment, not simply to turning 65.

Standardized Plan Letters

Medigap plans run from A through N (with several letters retired). Memorize the distinguishing features rather than every cell:

Closed plans: Plan C and Plan F (which paid the Part B deductible) are no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020. Someone eligible before that date may keep or buy them. Expect a question testing whether a newly eligible 65-year-old can purchase Plan F — the answer is no.

Guaranteed-Issue Rights Outside Open Enrollment

Delaware does not offer an annual "birthday rule" (California's rule that lets enrollees switch plans each year around their birthday with no underwriting). Outside the OEP, an applicant in Delaware can be medically underwritten unless a federal guaranteed-issue trigger applies, such as:

• Loss of employer or union group health coverage that paid after Medicare.
• An enrollee leaving a Medicare Advantage plan within the first 12 months (the "trial right").
• A Medicare Advantage plan leaving the service area or terminating.
• The Medigap insurer becoming insolvent or otherwise ending the policy through no fault of the insured.

These guaranteed-issue situations generally give a 63-day window to apply for a Medigap plan without underwriting.

Disclosure, Replacement, and Marketing Rules

Producers selling Medigap in Delaware must follow strict suitability and disclosure conduct:

• Deliver an Outline of Coverage at or before the time of application.
• Use the standardized replacement notice when the sale replaces existing Medigap or other health coverage, and document why the replacement benefits the client.
• Avoid duplicate coverage — it is an unfair practice to knowingly sell a beneficiary a policy that duplicates coverage they already have.
• No high-pressure tactics, no implying government endorsement, and no "twisting" a beneficiary out of a suitable plan.

How Medigap Differs From Medicare Advantage

Exam questions routinely test whether the candidate can separate Medigap from Medicare Advantage (Part C) — they are mutually exclusive purchases, and it is illegal to sell Medigap to someone enrolled in a Medicare Advantage plan unless they are disenrolling.

Because Medigap pairs with Original Medicare, a beneficiary keeps nationwide access to any Medicare-participating provider, while a Medicare Advantage member is generally tied to a network. A producer who recommends dropping a guaranteed-renewable Medigap plan to chase a low-premium Advantage plan must document the suitability rationale and use the replacement notice.

Premium Rating Methods

Though benefits are standardized, premiums are not — and Delaware allows insurers to price Medigap three different ways, which the exam may ask you to identify:

• Issue-age rated: premium is locked to the age at purchase; it does not rise simply because the insured grows older.
• Attained-age rated: premium starts lower but climbs as the insured ages — often the costliest over time.
• Community rated (no-age-rated): everyone pays the same premium regardless of age.

A younger-looking premium on an attained-age plan can mislead a buyer; part of suitable disclosure is explaining how the rating method affects lifetime cost.

Exam tip: When two answers seem plausible, pick the one giving the beneficiary clearer disclosure and avoiding pressure or duplication — that is the consumer-protection intent the state-law portion rewards.