3.2 Kentucky Medicare Supplement (Medigap) Regulations
Key Takeaways
- Kentucky grants a 6-month Medigap open enrollment period beginning the first day of the month the applicant is age 65 or older AND enrolled in Medicare Part B (806 KAR 17:570).
- Effective January 1, 2024, Kentucky extended a 6-month open enrollment period to under-65 Medicare beneficiaries (KRS 304.14-525).
- Kentucky's Medigap 'birthday rule' lets enrollees switch to a same-letter plan from any insurer on a guaranteed-issue basis within 60 days of their birthday.
- Medigap plans are federally standardized as Plans A, B, D, G, K, L, M, and N; Plans C and F are closed to those who became Medicare-eligible on or after January 1, 2020.
- Insurers may use attained-age, issue-age, or community rating, but may not rate up for health status during open enrollment or guaranteed-issue periods.
The 6-Month Open Enrollment Window
Medicare Supplement insurance (often called Medigap) fills gaps in Original Medicare such as the Part A hospital deductible, Part B coinsurance, and excess charges. Kentucky's Medigap rules sit in 806 Kentucky Administrative Regulation (KAR) 17:570.
Kentucky guarantees a 6-month open enrollment period that 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 window the consumer receives the strongest protections in the Medigap system:
- Guaranteed issue — the insurer must accept the applicant regardless of health.
- No pre-existing condition waiting period if the applicant had 6 months of prior creditable coverage.
- No health-based rate-up — the applicant pays the same rate as a healthy person of the same age.
- Any plan — the applicant may pick any Medigap letter the carrier offers.
New: Under-65 Open Enrollment (Effective 2024)
Under KRS 304.14-525, effective January 1, 2024, a person who becomes Medicare-eligible before age 65 (typically due to disability) also gets a 6-month open enrollment period for all Medigap plans, starting the first day of the month they enroll in Part B. This corrected a long-standing gap where younger disabled beneficiaries had no guaranteed Medigap access.
New: Kentucky Birthday Rule
Kentucky now offers a birthday rule: an existing Medigap policyholder may switch to a Medigap plan of the same letter from any insurer on a guaranteed-issue basis within 60 days following their birthday each year. The new plan cannot impose new underwriting or pre-ex periods. This is a high-yield, recently added Kentucky-specific fact.
Why Open Enrollment Matters So Much
Outside these windows, Medigap is medically underwritten in Kentucky — the carrier can ask health questions, decline an applicant, or charge more. So a healthy 67-year-old who skipped Medigap at 65 and now wants to buy may be turned down entirely. Producers should counsel clients to enroll during the 6-month window or align a switch with the birthday rule to keep guaranteed-issue protection. The open enrollment period runs once; it does not reset annually.
Guaranteed-Issue Triggering Events
Beyond open enrollment, federal and Kentucky law grant guaranteed-issue rights after certain 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 insured moves out | Return to Medigap |
| 'Trial right' — tried Medicare Advantage in first year, want to switch back | Return to prior or comparable Medigap |
| Medigap insurer becomes insolvent or misled the insured | Switch to comparable plan |
| Loss of Medicaid eligibility | Buy Medigap (per DOI Advisory Opinion 2023-05) |
Standardized Plans
Medigap benefits are federally standardized, so a 'Plan G' offers identical core benefits from every carrier — they compete only on price and service.
| Plan | Distinguishing feature |
|---|---|
| A | Core benefits only (baseline) |
| B | Core + Part A deductible |
| D | Broad coverage, no Part B excess charges |
| G | Most comprehensive plan open to new enrollees; covers Part B excess; insured pays the Part B deductible |
| K | 50% cost sharing with annual out-of-pocket maximum |
| L | 75% cost sharing with annual out-of-pocket maximum |
| M | 50% of Part A deductible |
| N | Copays for office and ER visits |
Plans C and F cover the Part B deductible and are closed to anyone who became Medicare-eligible on or after January 1, 2020. Newly eligible beneficiaries typically choose Plan G as the richest available option.
Rating Methods and Pre-Existing Rules
Kentucky permits three rating methods, which the producer must be able to compare for clients:
- Attained-age — premium rises as the insured ages (cheapest initially, most expensive later).
- Issue-age — premium set at the age of purchase; does not rise with age.
- Community — same premium for all insureds regardless of age.
Rate increases must be filed with the DOI. Outside open enrollment or a guaranteed-issue event, an insurer may impose a pre-existing condition waiting period of up to 6 months, reduced day-for-day by prior creditable coverage. A common trap: standardization is federal, but the open enrollment, birthday rule, and under-65 expansion are Kentucky-specific rules tested on this exam.
Marketing and Replacement Safeguards
Kentucky also regulates how Medigap is sold. A producer must deliver the official 'Guide to Health Insurance for People with Medicare' (the federal Medigap buyer's guide) at or before application, and an Outline of Coverage that summarizes benefits, exclusions, and premiums. When replacing an existing Medigap policy, the producer must provide a replacement notice and may not engage in 'twisting' (misrepresentation to induce a switch) or high-pressure tactics. Selling a duplicate Medigap policy — coverage the consumer does not need — is a prohibited practice.
These consumer-protection rules round out the Medigap material the exam tests alongside the enrollment and standardization facts.
Under Kentucky's Medigap 'birthday rule' effective in recent years, an existing policyholder may switch insurers on a guaranteed-issue basis within how long after their birthday, and to what plan?
When does Kentucky's 6-month Medicare Supplement open enrollment period begin for someone turning 65?
Which Medigap plans are closed to consumers who first became eligible for Medicare on or after January 1, 2020?