3.2 New Jersey Medicare Supplement (Medigap) Regulations

The New Jersey Birthday Rule

Most states give Medicare beneficiaries only the one-time federal open-enrollment window plus a few guaranteed-issue events. New Jersey is one of a small group of states (with California, Oregon, Idaho, Illinois, Louisiana, and a few others) that adds an annual Birthday Rule, and the exam loves to test it.

How it works

Each year, for a window of 30 days following the enrollee's birthday, a Medigap policyholder may switch to any Medigap plan with equal or lesser benefits, offered by any carrier, with:

• No medical underwriting - the carrier may not ask health questions
• No denial for health status and no surcharge for prior conditions
• No new pre-existing condition waiting period carried over from the prior plan

Exam Tip: The single most-tested limitation is equal or lesser benefits. You may move from Plan G to Plan N, or G to A, but you can never use the Birthday Rule to upgrade (e.g., N to G) - an upgrade would require full underwriting.

Worked example

Maria turns 70 on March 15 and holds Plan G. Between March 15 and roughly April 14 she may, without any health questions, switch to Plan N, Plan D, Plan A, or another Plan G with a cheaper carrier - all equal or lesser than G. She cannot use the rule to jump to Plan F (more comprehensive, and also closed to her as a post-2020 enrollee). Her new premium is set on attained age, not on her diabetes diagnosis.

Open Enrollment, Guaranteed Issue, and Standardized Plans

The 6-month Medigap open enrollment

Separate from the annual Birthday Rule, 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:

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.

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.