3.2 Maryland Medicare Supplement (Medigap) Regulations

The Federal 6-Month Open Enrollment Period

Every Medicare beneficiary gets a one-time Medigap Open Enrollment Period (OEP) that lasts 6 months and begins on the first day of the month in which the person is both age 65 or older AND enrolled in Medicare Part B. This is federal law and applies in Maryland.

During this 6-month window the applicant has full guaranteed issue:

• Must be accepted regardless of health history.
• No pre-existing condition waiting period if the person had at least 6 months of prior creditable coverage (otherwise up to a 6-month look-back applies).
• Cannot be charged a higher rate because of health conditions.
• May choose any standardized plan (A through N) the carrier offers.

Exam tip: The OEP trigger is the later of turning 65 or enrolling in Part B. A 67-year-old still working who finally takes Part B starts a fresh 6-month OEP then. Missing this window means future purchases may require medical underwriting outside protected events.

Other Federal Guaranteed-Issue Triggers

Maryland's Birthday Rule (Effective July 1, 2023)

Maryland is one of a small group of states with an annual underwriting-free switch window. Note this CORRECTS older study material that called it "continuous open enrollment": Maryland does not let you switch any plan any day of the year. Instead, the Birthday Rule applies.

Key features of the Maryland Birthday Rule:

• Who: A Maryland resident who already has an active Medigap policy.
• When: A window that begins on the policyholder's birthday and runs 30 days after it.
• Underwriting: Guaranteed issue — no health questions, no pre-existing waiting period.
• Limit: You may move only to a plan of equal or lesser benefits, with any carrier.
• Notice: The current carrier must notify the policyholder 30 to 60 days before the window opens.
• Effective date: New coverage starts the first of the month after the birthday month.

Worked example: A Maryland enrollee has Plan G and turns 70 on March 12. From March 12 through about April 11 she may switch to another carrier's Plan G or a lesser plan (such as N or D) without underwriting to lower her premium. She could NOT use the Birthday Rule to upgrade from N to G.

Standardized Plans and Rating

Medigap plans are federally standardized so Plan G from any carrier covers exactly the same benefits; carriers compete only on price and service. Maryland follows these standards.

Why C and F are closed: Federal law (MACRA) barred plans that cover the Part B deductible for people first Medicare-eligible on or after January 1, 2020. Someone who had Plan F before 2020 may keep it.

Rating Method — Correcting a Common Myth

Maryland does NOT require community rating for Medigap. According to the MIA Medicare Supplement Rate Guide, most Maryland carriers use attained-age rating (premium rises as you get older), and some use issue-age rating (premium set by age at purchase, no age increases thereafter). Only a minority of carriers community-rate. So a 75-year-old in Maryland may pay more than a 65-year-old for the same plan. Memorize the three methods:

• Attained-age: increases with current age (cheapest early, costliest later).
• Issue-age: locked to age at purchase; rises only for inflation/benefit changes.
• Community: same for all ages regardless of when purchased.

What Medigap Covers and Excludes

Medigap fills the "gaps" in Original Medicare (Parts A and B) — coinsurance, copays, and deductibles. It does not include prescription-drug coverage; beneficiaries buy a separate Part D plan for that. A Medigap policy covers only one person, so a married couple needs two policies. It cannot be sold to someone enrolled in a Medicare Advantage (Part C) plan, because Advantage replaces Original Medicare. Selling a duplicate or unneeded Medigap policy is an unfair trade practice the MIA can sanction.

Exam tip: Two of the most testable Maryland Medigap facts are that the state uses the Birthday Rule (not year-round switching) and that it does not require community rating — most plans are attained-age rated. Older study guides get both wrong, so trust these corrected facts.