3.2 Maine Medicare Supplement (Medigap) Regulations

The Federal Medigap Open Enrollment Window

Medicare Supplement (Medigap) policies pay costs Original Medicare leaves behind — the Part A and Part B deductibles, coinsurance, and copays. Every state, including Maine, honors the federal 6-month open enrollment period, and the exam tests its trigger precisely.

The 6-month clock starts 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 applicant gets full guaranteed issue of any standardized plan the carrier sells, with no medical underwriting and no pre-existing condition waiting period.

Exam tip: Both conditions must be met. A 66-year-old who delays Part B does not start the clock until Part B begins.

Maine's Special Ongoing Protections

Maine is more generous than most states, but the rules are precise — and the existing study text oversimplified them. Know these three Maine-specific facts:

Unlike states with truly unlimited continuous issue of any plan, Maine guarantees year-round issue only when you move to equal or fewer benefits (you cannot freely upgrade to a richer plan without underwriting outside the windows). A carrier may apply a surcharge — for example, a 20% first-year surcharge for applying to Plan A outside the annual open-enrollment month.

The Medicare Advantage Trial Right

Federal law gives a 12-month trial right to return to Medigap after first joining a Medicare Advantage (MA) plan. Maine extends this trial right to 3 years, a frequently tested distinction. Beneficiaries leaving MA also get 90 days to obtain a Medigap policy without underwriting.

Other Guaranteed-Issue Triggering Events

Beyond the windows above, federal law (which Maine honors) grants guaranteed issue after certain events. The insured generally has 63 days from the loss of prior coverage to apply:

Exam trap: Note the two different clocks — 63 days for loss-of-coverage guaranteed issue, but 90 days for the Maine-specific MA disenrollment and continuous-coverage rules. The exam mixes these to catch careless readers.

Standardized Plans (A through N)

Medigap plans are federally standardized; a Plan G from any Maine carrier covers the same benefits as a Plan G from any other — carriers compete on price and service, not benefits.

Note: Plans C and F cover the Part B deductible, so they are closed to anyone who became Medicare-eligible on or after January 1, 2020. Newly eligible beneficiaries gravitate to Plan G as the most comprehensive available option.

Community Rating in Maine

Maine mandates community rating for Medigap, the most consumer-protective pricing method:

• Premiums are the same regardless of age or gender.
• Carriers cannot charge more based on health status or claims history.
• A carrier may charge a higher rate for smokers.
• Rates can still rise for everyone through across-the-board annual rate actions.

Contrast this with attained-age rating (premium rises as the insured ages) and issue-age rating (premium set by age at purchase, then level) used in many other states.

Worked Scenario

Margaret, 80, and Tom, 67, apply to the same Maine carrier for Plan G. Under community rating they receive the same base premium despite the 13-year age gap. If Margaret smokes, the carrier may add a smoker surcharge — but it may not charge her more simply for being older. This is exactly the kind of fact pattern the state-law portion uses to test the difference between community and attained-age rating.

What Medigap Does NOT Cover

A Medigap policy supplements Original Medicare only. It does not pay for:

• Long-term custodial care (see 3.3 for LTC insurance)
• Routine dental, vision, or hearing aids
• Private-duty nursing
• Prescription drugs (those require a separate Part D plan)

A single Medigap policy covers one person; spouses each need their own policy. It is also illegal for an agent to sell a Medigap policy to someone already enrolled in a Medicare Advantage plan unless the buyer is disenrolling from MA — a frequently tested unfair-practice rule.

Putting the Maine Rules Together

Exam tip: Maine's reputation for strong Medigap rights is real, but examiners reward precision. The protective rules are not "buy any plan anytime" — they are the Plan A annual window, the equal-or-lesser year-round switch, and the 3-year MA trial right. Distractors that overstate the protection (e.g., "unlimited guaranteed issue of any plan year-round") are wrong.