3.2 Georgia Medicare Supplement (Medigap) Regulations
Key Takeaways
- The 6-month Medigap open enrollment period starts the first day of the month the applicant is both 65+ and enrolled in Medicare Part B — it is one-time and never repeats.
- During open enrollment there is no medical underwriting: guaranteed issue, no pre-existing waiting period, and standard rates regardless of health.
- Plans C and F are sold only to beneficiaries first eligible for Medicare before January 1, 2020; newly eligible beneficiaries buy Plan G instead.
- Medigap policies carry a 30-day free look, and Georgia requires a federally compliant Outline of Coverage delivered at application.
- Replacement of a Medigap policy requires a signed replacement notice; stacking duplicate Medigap coverage is prohibited.
The One-Time 6-Month Open Enrollment Period
The single most tested Medigap fact: the Medicare Supplement open enrollment period lasts 6 months and begins on the first day of the month the individual is both age 65 or older AND enrolled in Medicare Part B. It happens once and cannot be repeated or deferred. Missing it is costly because, afterward, insurers may apply medical underwriting.
Protections inside the 6-month window
| Protection | Effect |
|---|---|
| Guaranteed issue | Insurer must accept the applicant regardless of health |
| No health underwriting | Cannot ask health questions to deny or surcharge |
| No pre-existing waiting period | If the applicant had 6 months of prior creditable coverage, no exclusion applies |
| Plan of choice | May buy any Medigap plan letter the insurer offers (A–N) |
Exam tip: Do not confuse the 6-month Medigap open enrollment with the 7-month Initial Enrollment Period for Medicare Part B (3 months before, the birthday month, 3 months after) or the Medicare Advantage Open Enrollment (Jan 1–Mar 31). They are three different windows.
Pre-Existing Conditions Outside Open Enrollment
Once the 6-month window closes and no guaranteed-issue trigger applies, an insurer may:
- Medically underwrite and decline the applicant; and
- Impose up to a 6-month pre-existing condition waiting period for conditions treated or diagnosed in the prior 6 months.
Prior creditable coverage reduces or eliminates that waiting period day-for-day.
Guaranteed-Issue Triggers After Open Enrollment
Federal law (followed in Georgia) reopens guaranteed issue for specific events; the applicant generally has 63 days from the loss of coverage to apply.
| Triggering event | Guaranteed-issue right |
|---|---|
| Employer group health plan ends | Buy Medigap within 63 days |
| Medicare Advantage plan leaves the area or you move out of its service area | Return to Medigap |
| "Trial right" — first MA enrollment, disenroll within 12 months | Return to Medigap |
| Medigap insurer becomes insolvent or misrepresents the plan | Switch to a comparable plan |
| Losing Medicaid or losing other supplemental coverage through no fault | Buy Medigap |
Standardized Plans A Through N
Medigap plans are federally standardized — every Plan G is identical in benefits across all insurers, so consumers compare on price and service, not coverage. Insurers compete on premium, not benefit design.
| Plan | Defining feature |
|---|---|
| A | Core/basic benefits only (every insurer that sells Medigap must offer A) |
| B | Basic + Part A deductible |
| C | Comprehensive incl. Part B deductible — pre-2020 eligibles only |
| D | Like C without Part B deductible/excess |
| F | Most comprehensive (covers Part B deductible & excess) — pre-2020 eligibles only; also sold as high-deductible F |
| G | Like F but does not cover the Part B deductible — the top seller for newly eligible beneficiaries; high-deductible G available |
| K | 50% cost-sharing with an out-of-pocket maximum |
| L | 75% cost-sharing with an out-of-pocket maximum |
| M | 50% of the Part A deductible |
| N | Copays of up to $20 (office) / $50 (ER); does not cover Part B excess |
2020 rule (MACRA): Plans that pay the Part B deductible (C and F) are closed to anyone first eligible for Medicare on or after January 1, 2020. Those beneficiaries buy Plan G or Plan N instead.
Rating Methods
Georgia lets insurers file any of three rating methods; rate filings require Commissioner review.
| Method | How premium behaves |
|---|---|
| Attained-age | Lowest at issue, rises as the insured ages — cheapest now, costliest later |
| Issue-age | Based on age at purchase; does not rise from aging alone |
| Community | Same premium for everyone regardless of age |
Free Look, Outline of Coverage, and Replacement
Georgia Medigap policies carry a 30-day free look (not 10). At or before application the producer must deliver a federally compliant Outline of Coverage and the "Choosing a Medigap Policy" guide. It is illegal to sell a beneficiary a Medigap policy that duplicates coverage they already have (anti-stacking). Replacing an existing Medigap policy requires a signed replacement notice and an honest comparison.
Medicare SELECT
Medicare SELECT is a Medigap policy that uses a network of hospitals for non-emergency Part A care in exchange for a lower premium. Benefits are the same standardized letters; the only difference is the network requirement. A SELECT enrollee dissatisfied with the network has the right to switch to a standard (non-SELECT) Medigap policy of equal or lesser value with the same insurer.
What Medigap Does and Does Not Cover
Medigap fills the "gaps" in Original Medicare (Parts A and B) — deductibles, coinsurance, and copays. It is secondary to Medicare and pays only after Medicare pays its share. Key boundaries the exam tests:
- Medigap does not include prescription drug coverage — beneficiaries need a separate Part D plan; selling Medigap that promises Rx is a misrepresentation.
- Medigap does not work with a Medicare Advantage (Part C) plan; it is illegal for a producer to sell Medigap to someone enrolled in MA unless they are disenrolling.
- One Medigap policy covers one person — spouses each need their own policy.
- Plans K and L include an annual out-of-pocket maximum; after the insured hits it, the plan pays 100% of covered services for the rest of the year.
Suitability, Disclosure, and Marketing Rules
Georgia and the federal NAIC model impose strict conduct standards on Medigap sales:
| Rule | Requirement |
|---|---|
| Outline of Coverage | Delivered at application or earlier |
| "Choosing a Medigap Policy" guide | Must be given to the applicant |
| Replacement notice | Signed by applicant and producer when replacing existing coverage |
| No high-pressure tactics | Cold-lead and "twisting"/"churning" prohibited |
| Suitability | Producer must reasonably believe the policy meets the applicant's needs |
Exam tip: "Twisting" is inducing a replacement through misrepresentation; "churning" is replacing a policy with the same insurer to generate a new commission. Both are prohibited unfair trade practices and surface frequently in Medigap scenario questions.
When does the one-time 6-month Medicare Supplement open enrollment period begin?
A beneficiary who first became eligible for Medicare in 2023 wants the most comprehensive Medigap plan available to her. Which plan should the producer recommend?