3.2 Illinois Medicare Supplement (Medigap) Regulations
Key Takeaways
- Medicare Supplement policies in Illinois carry a 30-day free look, longer than the 10-day health free look
- The 6-month Medigap open enrollment begins the first month a beneficiary is both age 65 or older and enrolled in Medicare Part B
- During open enrollment coverage is guaranteed issue with no health rating and no pre-existing waiting period
- Guaranteed issue rights also arise from specific triggering events, generally within a 63-day window
- Plans are federally standardized A through N; Plans C and F are closed to anyone first eligible on or after January 1, 2020
What Medigap Does — and the 30-Day Free Look
A Medicare Supplement (Medigap) policy pays the deductibles, coinsurance, and copayments that Original Medicare (Parts A and B) leaves to the beneficiary. It does not replace Medicare; it fills the gaps. A Medigap policy cannot duplicate Medicare Advantage (Part C) — it is illegal to sell Medigap to someone enrolled in a Medicare Advantage plan unless they are disenrolling.
Illinois requires a 30-day free look on every Medicare Supplement policy — three times longer than the 10-day window for ordinary health insurance. Within 30 days of delivery the buyer may return the policy for a full premium refund, no questions asked. One nuance Illinois allows: a company may charge a one-time application fee that it is not required to refund if the policy is returned during the free look.
Exam trap: Free-look lengths cluster around two numbers. 10 days = individual health and individual disability. 30 days = Medicare Supplement and long-term care. Memorize the pairing.
The 6-Month Open Enrollment Period
The single most valuable protection is the Medigap Open Enrollment Period (OEP) — a one-time, 6-month window. It begins on the first day of the first month in which the person is both (1) age 65 or older and (2) enrolled in Medicare Part B. It cannot be repeated.
During the OEP a Medigap insurer must:
| Protection | Effect |
|---|---|
| Guaranteed issue | Must accept the applicant for any plan it sells |
| No medical underwriting | Cannot ask health questions to deny |
| No health rating | Cannot charge more for health status |
| No pre-existing wait | (Limited wait only if no prior creditable coverage) |
Worked Example
A man turns 65 on June 18 and his Part B coverage starts July 1. His Medigap OEP runs July 1 through December 31 (six months from the first of the month he is 65 and on Part B). If he applies for any Plan G in October, the insurer must issue it at the standard rate regardless of his diabetes diagnosis. If he waits until the following February, the insurer may underwrite and decline him.
Outside Open Enrollment and Guaranteed-Issue Rights
Apply after the 6-month OEP closes and, unless a special right applies, the insurer may medically underwrite — ask health questions, charge more, impose a pre-existing waiting period, or decline outright. Illinois law still preserves several guaranteed-issue (GI) triggering events that let the beneficiary buy certain Medigap plans without underwriting, generally within 63 days of losing the prior coverage.
| Triggering Event | Guaranteed-Issue Right |
|---|---|
| Loss of employer/union retiree coverage | Buy Medigap within 63 days |
| Medicare Advantage plan leaves the service area or terminates | Buy Medigap within 63 days |
| Medigap insurer becomes insolvent or commits misrepresentation | Switch to a comparable plan |
| Move out of a Medicare Advantage plan's network area | Buy Medigap within 63 days |
| Loss of Medicaid eligibility | Buy Medigap within 63 days |
The 12-Month Trial Right
If a beneficiary drops a Medigap policy to try Medicare Advantage for the first time, they have a 12-month trial right: within those 12 months they may return to the same Medigap policy (if still sold) or buy a comparable plan, guaranteed issue, no health questions. The right exists only for that first 12 months of the Advantage enrollment.
Standardized Plans A Through N
Medigap plans are federally standardized, so Plan G from any Illinois carrier covers the same benefits — only price and service differ. This makes apples-to-apples comparison the agent's selling point.
| Plan | Notable Feature |
|---|---|
| A | Core benefits only |
| B | Core + Part A deductible |
| C | Comprehensive; closed to those first eligible 1/1/2020 or later |
| D | Like C without Part B excess charges |
| F | Most comprehensive; closed to those first eligible 1/1/2020 or later |
| G | Like F but does not pay the Part B deductible |
| K / L | 50% / 75% cost-sharing with annual out-of-pocket maximum |
| M / N | Reduced Part A deductible (M) / small office and ER copays (N) |
Why C and F closed: A 2015 federal law (MACRA) barred newly eligible beneficiaries from buying any Medigap plan that pays the Part B deductible. Plans C and F do; therefore anyone first eligible for Medicare on or after January 1, 2020 cannot purchase them. Plan G is now the most comprehensive option for new enrollees.
Rating Methods
Illinois permits three premium-rating methods, and the agent must disclose which a policy uses:
- Attained-age — premium rises as the insured ages (lowest entry cost, steepest increases).
- Issue-age — premium fixed by age at purchase; does not rise from aging alone.
- Community-rated (no-age) — every insured pays the same regardless of age.
All rate-increase requests must be filed with IDOI, and the producer must disclose to the buyer which method a given policy uses so the client understands how premiums will behave over time.
Marketing, Disclosure, and the Birthday Rule
Medigap solicitation in Illinois is tightly policed. The agent must deliver an Outline of Coverage at or before application, may not sell a policy that duplicates the applicant's existing coverage, and must complete a replacement comparison if the sale replaces an in-force Medigap or Medicare Advantage plan. High-pressure tactics, twisting, and misrepresenting plan benefits are prohibited and carry IDOI penalties.
Illinois also provides an annual birthday rule: for a window around the insured's birthday each year, a Medigap policyholder may switch to a plan with equal or lesser benefits with the same or another carrier without new medical underwriting. This lets seniors shop for a lower premium on comparable coverage even years after their one-time open enrollment has closed — a protection examiners increasingly test.
Exam tip: The 6-month open enrollment is one-time and tied to age 65 plus Part B; the birthday rule recurs every year but only allows a move to equal or lesser benefits. Do not blend the two.
A woman turns 65 on August 10 and her Medicare Part B begins September 1. When does her one-time Medigap open enrollment period run?
Which Medicare Supplement plans are closed to anyone first eligible for Medicare on or after January 1, 2020?
An Illinois Medigap buyer returns his policy 18 days after delivery, having filed no claim. What applies?
A beneficiary's Medicare Advantage plan stops serving her county. What right does Illinois preserve for her?