3.2 New Jersey Medicare Supplement (Medigap) Regulations
Key Takeaways
New Jersey has no annual Medigap birthday rule; outside open enrollment and federal guaranteed-issue events, a carrier may underwrite a plan change.
Medigap open enrollment is a one-time 6-month window beginning the first month a person is both age 65+ and enrolled in Medicare Part B.
During open enrollment and federal guaranteed-issue events, carriers must issue at standard rates with no pre-existing condition waiting period.
Medigap plans are federally standardized A through N; Plans C and F are closed to anyone newly Medicare-eligible on or after January 1, 2020.
New Jersey allows attained-age and issue-age rating but rate filings and changes must be approved by DOBI.
No New Jersey Birthday Rule
Some states give Medigap enrollees an annual birthday-rule window to switch to a plan with equal or lesser benefits without medical underwriting (California, Oregon, Idaho, Illinois and Louisiana are examples). New Jersey is not one of them. In New Jersey, a Medigap enrollee changes plans without underwriting only during the one-time 6-month open enrollment or a federal guaranteed-issue event; otherwise the carrier may ask health questions.
Exam Tip: Do not apply another state's birthday rule to a New Jersey question.
Open Enrollment, Guaranteed Issue, and Standardized Plans
The 6-month Medigap open enrollment
Every beneficiary gets a one-time, 6-month Medigap open-enrollment period that begins the first day of the month in which the person is both age 65 or older and enrolled in Medicare Part B. During this window the carrier must:
- Guarantee issue any plan it sells - no health questions
- Charge standard rates regardless of health
- Impose no pre-existing condition waiting period
Miss this 6-month window and apply later outside a guaranteed-issue trigger, and the carrier may underwrite, surcharge, or decline - so the exam frames it as a one-shot opportunity.
Federal guaranteed-issue triggers
Outside open enrollment, federal law (which New Jersey honors) creates guaranteed-issue rights, generally with a 63-day application window:
| Triggering event | Guaranteed-issue right |
|---|---|
| Lose employer/retiree group coverage | Buy Medigap within 63 days |
| Medicare Advantage plan exits the area or you move out of it | Buy Medigap |
| Medigap carrier becomes insolvent or ends the plan | Switch to a comparable plan |
| Trial right - first-time MA enrollee | Return to Medigap within 12 months |
The trial right lets someone who tries Medicare Advantage for the first time switch back to a Medigap plan within 12 months, guaranteed issue.
Standardized plans A through N
Medigap plans are federally standardized, so Plan G from one carrier covers exactly what Plan G covers from another - only price and service differ.
| Plan | Key feature |
|---|---|
| A | Core benefits only |
| B | Core + Part A deductible |
| C / F | Most comprehensive - closed to those newly Medicare-eligible on/after Jan 1, 2020 |
| D / G | Like C/F but no Part B deductible coverage |
| K / L | 50% / 75% cost-sharing with annual out-of-pocket maximum |
| M | 50% of Part A deductible |
| N | Copays for some office and ER visits |
Note: Because Plans C and F pay the Part B deductible, they are barred for anyone first eligible for Medicare in 2020 or later. Plan G is the comprehensive choice for new enrollees.
Rating in New Jersey
New Jersey permits attained-age rating (premium rises as the insured ages) and issue-age rating (premium set by age at purchase, then level). Community rating is not required for Medigap, but every rate and rate change must be filed with and approved by DOBI.
Disclosure, replacement, and what Medigap does NOT cover
When replacing one Medigap policy with another, the producer must deliver a Guide to Health Insurance for People with Medicare and a completed replacement notice, and may not sell a second Medigap policy that duplicates coverage the client already has - selling a duplicate is an unfair trade practice. Producers must also confirm the client is not better served keeping existing coverage; high-pressure replacement of Medigap is specifically prohibited.
Know the limits Medigap shares nationwide: a Medigap policy supplements Original Medicare only - it cannot be paired with a Medicare Advantage plan, does not include prescription-drug coverage (that requires a separate Part D plan for anyone with a post-2006 policy), and never covers long-term custodial care, dental, vision, or hearing aids. A frequent exam trap pairs Medigap with Medicare Advantage; the correct answer is that the two cannot legally be held together for the same enrollee.
A New Jersey Medigap policyholder wants to switch plans three years after her open enrollment ended, with no guaranteed-issue event. What applies?
The new carrier may medically underwrite the application
Switch to any plan, including one with greater benefits
Cancel coverage and receive a refund of all premiums
Lower the premium on the existing plan once per year
When does the one-time 6-month Medigap open-enrollment period begin?
The day a person first applies for Social Security
30 days after a person's 65th birthday
The first day of the month the person is both 65+ and enrolled in Medicare Part B
The first month of any calendar year after turning 65
A client became Medicare-eligible in 2023 and wants the most comprehensive Medigap plan available to her. Which plan should the producer recommend?
Plan F
Plan C
Plan G
Plan A
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