3.2 Hawaii Medicare Supplement (Medigap) Regulations

How Medigap Fits Into Medicare

A Medicare Supplement policy (Medigap) is private insurance that pays the gaps in Original Medicare — Part A and Part B deductibles, coinsurance, and copayments. It does not work with Medicare Advantage (Part C); it is illegal for a producer to sell a Medigap policy to someone enrolled in a Medicare Advantage plan unless they are disenrolling. Medigap also does not include prescription-drug coverage, which beneficiaries get separately through a Part D plan. The exam frequently tests this pairing: Original Medicare + Medigap + standalone Part D versus an all-in-one Medicare Advantage plan.

Standardized Plans (A through N)

Under federal law every Medigap plan sold in Hawaii must match a standardized benefit package identified by a letter. Two carriers selling "Plan G" must offer identical benefits; they compete only on price and service. This standardization is the whole consumer-protection point — it lets a buyer compare carriers apples-to-apples.

Trap: candidates pick Plan F as "the best." It is comprehensive, but it is no longer available to people who became Medicare-eligible on or after January 1, 2020 because of the Medicare Access and CHIP Reauthorization Act (MACRA). For new beneficiaries, Plan G is the most complete option.

The Six-Month Open Enrollment Period

The single most-tested Medigap fact is the Medigap Open Enrollment Period (OEP): a one-time, six-month window that begins on the first day of the month in which the person is both age 65 or older AND enrolled in Medicare Part B. Both conditions must be true to start the clock, and the window never repeats.

During this OEP the applicant enjoys three protections:

1. Guaranteed issue — the carrier must accept the application regardless of health.
2. No medical underwriting — health questions cannot be used to deny or surcharge.
3. No pre-existing condition waiting period if the applicant had at least six months of prior creditable coverage; otherwise a pre-existing exclusion of up to six months may apply.

Worked example: Leilani turns 65 on March 12 and enrolls in Part B effective March 1. Her Medigap OEP runs March 1 through August 31. If she waits until September to apply, she loses guaranteed issue and the carrier may underwrite and decline her.

Guaranteed-Issue Rights Outside Open Enrollment

Even after the six-month window closes, federal law grants guaranteed-issue (GI) rights in specific situations where someone involuntarily loses coverage. These are tested as a list — memorize the triggers:

The recurring number is the 63-day window to apply after the qualifying event. Note Hawaii does not add a state "birthday rule." States like California and Oregon let beneficiaries switch to an equal-or-lesser Medigap plan each year around their birthday without underwriting; Hawaii has no such annual switching right. If a question offers "during your birthday month" as an answer for Hawaii, it is wrong.

Suitability, Replacement, and Disclosure Duties

Hawaii adopts the NAIC Medicare Supplement model rules, which impose producer duties designed to stop churning and pressure sales:

• Outline of coverage must be delivered no later than at policy delivery.
• The NAIC "Guide to Health Insurance for People with Medicare" must be provided to every applicant.
• A 30-day free-look applies to Medigap policies — longer than the 10-day individual-health free-look — so a buyer can return the policy for a full refund.
• Replacement requires a signed replacement notice and a determination that the new policy is suitable; selling a duplicate Medigap policy is prohibited.
• Excess insurance / duplication is barred: a producer may not knowingly sell coverage that duplicates benefits the beneficiary already has.

Marketing Restrictions

Prohibited practices include high-pressure tactics, cold-lead advertising disguised as government mailings, twisting, and misrepresenting affiliation with Medicare or a government agency. Producers cannot state or imply that a Medigap policy is endorsed by the federal government. When two answer choices both seem defensible, choose the one that gives the Medicare beneficiary fuller disclosure and avoids unnecessary replacement — the consumer-protection answer almost always wins on this exam.