3.2 Idaho Medicare Supplement (Medigap) Regulations

What Medigap Is

Medicare Supplement insurance (Medigap) is private coverage that pays the gaps in Original Medicare (Parts A and B) — deductibles, coinsurance, and copayments. Medigap does not work with Medicare Advantage (Part C); it is illegal to sell a Medigap policy to someone enrolled in Advantage who intends to keep it. Plans are federally standardized, so a Plan G from one Idaho carrier covers exactly the same benefits as a Plan G from another — carriers compete only on price and service.

The 6-Month Open Enrollment Period

The Medigap Open Enrollment Period (OEP) is a one-time, 6-month window that begins on the first day of the month the insured is both:

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

During this window the applicant has full protections:

• Guaranteed issue — the carrier must accept the application regardless of health.
• No pre-existing condition exclusions may be applied.
• No health-based rate-up — the same rate a healthy applicant would pay.

Miss this window and, outside a guaranteed-issue trigger, the carrier may medically underwrite and decline or surcharge the applicant. The OEP does not restart and cannot be extended for late Part B enrollment in most cases.

Standardized Plans A through N

The federal benefit grid uses letters. High-yield rows:

Plans C and F (which paid the Part B deductible) are closed to anyone newly eligible for Medicare on or after January 1, 2020; those already eligible before then may still buy them. Plans K and L are the only standardized plans with an out-of-pocket cap.

All standardized plans except A, K, and L cover the Part A hospital coinsurance plus 365 extra hospital days and the first three pints of blood. Because benefits are fixed by letter, a producer who claims one carrier's Plan G "covers more" than another's is making a misrepresentation — the only honest differences are premium, rate stability, and service. Idaho permits three rating methods: attained-age (rises with age), issue-age (set at purchase age), and community-rated (same for all). Knowing which method a policy uses is essential to comparing long-run cost.

Idaho's Birthday Rule (Correction to Older Material)

Idaho does have a Birthday Rule. Effective March 1, 2022, Idaho joined California, Oregon, and a handful of other states in offering an annual guaranteed-issue window tied to the insured's birthday. Older guides (and the prior version of this chapter) stated Idaho had no Birthday Rule — that is out of date. Memorize the current rule:

• The window is 63 days, beginning on the policyholder's birthday.
• The enrollee may switch to a Medigap plan with equal or lesser benefits — never richer benefits — without medical underwriting.
• The switch can be to a different carrier or a lower-tier plan with the same carrier.
• It is an annual right; it can be used every year during the 63-day window.

Worked example: an Idaho insured on Plan G turns 70 on June 1. From June 1 through August 2 (63 days) she may move to another carrier's Plan G, or down to Plan N, with no health questions. She may not use the rule to upgrade from Plan N to Plan G — that requires underwriting.

The 30-Day Free Look

A new Medigap policyholder may return the policy within 30 days of delivery for a full premium refund if dissatisfied for any reason. Contrast this with the 10-day free look on individual health policies (Section 3.1) — the exam pairs these to test whether you know which product gets which window.

Guaranteed-Issue Rights Outside Open Enrollment

Beyond the OEP and the Birthday Rule, federal/state guaranteed-issue triggers force a carrier to accept an applicant without underwriting. Common situations:

• Loss of employer/union group coverage that paid after Medicare.
• Leaving a Medicare Advantage plan within the first 12 months (trial right).
• The applicant's Medicare Advantage or Medigap plan leaves the service area or terminates.
• The Medigap insurer becomes insolvent or the company violated/misrepresented the contract.

Exam Focus

Expect questions that separate the federal standardized structure (Plans A-N, the benefit grid) from state administration (free look, marketing rules, the Birthday Rule). Watch for: prohibited duplicate coverage (selling a Medigap when one already exists), required replacement notices, and bans on high-pressure or misleading marketing to seniors. When two answers seem plausible, pick the one giving the beneficiary clearer disclosure and avoiding pressure selling or unnecessary replacement.

Replacement and Disclosure Duties

When an agent replaces one Medigap policy with another, Idaho requires:

• A signed replacement notice comparing the old and new coverage.
• The "Choosing a Medigap Policy" buyer's guide delivered at or before application.
• An Outline of Coverage that lays out the standardized benefits.
• A statement that the new policy may impose a new pre-existing condition look-back if the applicant is underwritten outside a guaranteed-issue window.

Selling a beneficiary a second Medigap policy that duplicates existing coverage is prohibited; the agent must obtain a signed statement that the new policy will replace the old one. Stacking duplicate Medigaps, or selling Medigap to a Medicare Advantage enrollee who keeps Advantage, are unfair trade practices that draw DOI enforcement.

Quick Reference: Idaho Medigap Numbers

These six rows answer the bulk of Idaho Medigap questions; commit them to memory and you will recognize the distractors instantly.