3.2 Louisiana Medicare Supplement (Medigap) Regulations
Key Takeaways
- The Medigap open enrollment period lasts 6 months and starts the first day of the month you are both 65+ and enrolled in Medicare Part B.
- During open enrollment, guaranteed issue applies with no medical underwriting, surcharges, or pre-existing waiting periods.
- Medigap plans are federally standardized (Plans A, B, D, G, K, L, M, N) - Plans C and F are closed to those newly eligible on or after January 1, 2020.
- Specific triggering events create guaranteed-issue rights outside open enrollment, generally exercised within 63 days.
- Outside guaranteed-issue windows an insurer may impose up to a 6-month pre-existing condition look-back, reduced by prior creditable coverage.
What Medigap Is - and Is Not
A Medicare Supplement (Medigap) policy is private insurance that pays the "gaps" in Original Medicare (Parts A and B) - deductibles, coinsurance, and copayments. It is not Medicare Advantage (Part C), which replaces Original Medicare. A consumer cannot legally hold both a Medicare Advantage plan and a Medigap policy at the same time, and a producer who sells a Medigap policy to someone already enrolled in Advantage commits a prohibited practice. Medigap also does not include Part D drug coverage; that is purchased separately.
The 6-Month Open Enrollment Period
The single most important date on this exam is the Medigap Open Enrollment Period (OEP):
- Length: 6 months.
- Trigger: begins the first day of the month in which the individual is both age 65 or older AND enrolled in Medicare Part B.
- One-time: it does not repeat and is not the same as Medicare's fall Annual Election Period.
During the OEP the applicant gets full protection:
| Protection | Effect during OEP |
|---|---|
| Guaranteed issue | Insurer must accept the applicant for any plan it sells |
| No medical underwriting | Health questions cannot be used to deny coverage |
| No surcharge | Cannot charge more for health status |
| No pre-existing waiting period | Coverage for existing conditions begins immediately (if the applicant had prior creditable coverage) |
Worked example: Marie turns 65 on March 18 and enrolls in Part B effective March 1. Her 6-month OEP runs March 1 through August 31. If she applies for Plan G on August 30 she is guaranteed issue; if she waits until September 5 she can be medically underwritten and possibly declined.
Guaranteed-Issue Triggering Events
Outside the OEP, federal law (which Louisiana follows) grants guaranteed-issue rights when certain events occur, generally exercised within 63 days of losing the prior coverage:
| Triggering event | Right granted |
|---|---|
| Employer group health plan ends | Buy Medigap (typically Plan A, B, D, G, K, L, M, or N) |
| Medicare Advantage plan leaves the area or stops serving Medicare | Return to a Medigap plan |
| "Trial right" - dropped Medigap to try Advantage, switch back within 12 months | Get the prior Medigap plan back |
| Medigap insurer becomes insolvent or ends the plan through no fault of the insured | Buy a comparable Medigap plan |
| Losing Medicaid eligibility | Buy Medigap |
Note that guaranteed issue outside OEP generally does not let you pick any plan - it restricts you to specified plans (often A, B, D, G, K, L, M, N depending on the trigger).
Standardized Plans (Federally Set Letters)
Medigap benefits are federally standardized, so a Plan G in Louisiana covers the same benefits as a Plan G anywhere in the country - only the premium differs by insurer. Tested points:
| Plan | Key feature |
|---|---|
| A | Core benefits only (the mandatory base every insurer offering Medigap must sell) |
| B | Core + Part A deductible |
| D | Broad coverage; no Part B excess charges |
| G | Most comprehensive plan available to new enrollees; covers everything Plan F did except the Part B deductible |
| K | 50% cost-sharing with an annual out-of-pocket maximum |
| L | 75% cost-sharing with an annual out-of-pocket maximum |
| M | Pays 50% of the Part A deductible |
| N | Lower premium; copays apply for some office and ER visits |
Critical trap: Plans C and F are closed to anyone who became eligible for Medicare on or after January 1, 2020, because they covered the Part B deductible (which newly eligible beneficiaries must now pay out of pocket). Someone eligible before that date may still buy or keep C or F. There is no Plan E, H, I, or J - those letters were retired years ago, so any exam option offering "Plan I" is a distractor. Plan A is the standardized core, and every insurer that sells Medigap in Louisiana must offer Plan A.
Rating Methods
Louisiana permits three pricing methods, and the difference matters to a senior buyer:
- Issue-age rated - premium is based on your age when you buy; it does not rise simply because you grow older (it can still rise for inflation).
- Attained-age rated - premium is based on your current age and increases as you age - often cheapest at 65 but most expensive later.
- Community-rated (no-age-rated) - everyone pays the same premium regardless of age.
All rate increases must be filed with the LDI, and during the OEP an insurer cannot rate based on health.
Pre-Existing Conditions Outside Guaranteed Issue
| Situation | Pre-existing look-back |
|---|---|
| During the 6-month OEP | None |
| During a guaranteed-issue triggering event | None |
| Outside both windows | Up to a 6-month look-back may apply |
Creditable coverage (prior health coverage without a significant gap) reduces or eliminates any pre-existing waiting period - day-for-day.
Exam tips: (1) lock in "6 months, age 65 and Part B" for the OEP start; (2) remember 63 days for triggering events; (3) C and F are closed to people newly eligible on/after 1/1/2020 because they cover the Part B deductible; (4) attained-age policies get more expensive over time while issue-age policies do not rise with age.
When does the 6-month Medicare Supplement open enrollment period begin?
Why are Medigap Plans C and F unavailable to people who became Medicare-eligible on or after January 1, 2020?
A retiree loses her employer group health plan. How long does she generally have to exercise her guaranteed-issue right to buy a Medigap policy?
Which Medigap rating method results in premiums that increase as the insured grows older?