3.2 New York Medicare Supplement (Medigap) Regulations

Medigap Basics

Medicare Supplement (Medigap) policies fill the cost-sharing gaps in Original Medicare — deductibles, coinsurance, and copays for Parts A and B. They do not work with Medicare Advantage; a beneficiary cannot legally use both at the same time. Medigap plans are federally standardized into letter plans, so a Plan G from any carrier covers exactly the same benefits — only price and service differ. To buy Medigap a person must be enrolled in both Part A and Part B of Original Medicare; the policy covers only the named insured, so a married couple needs two separate policies.

Continuous Open Enrollment (New York's Signature Rule)

Federal law guarantees only a 6-month Medigap open enrollment starting the month a beneficiary is both 65+ and enrolled in Part B. Outside that window, most states let insurers medically underwrite — deny, surcharge, or impose waiting periods.

New York is one of just four states (with Connecticut, Massachusetts, and Maine) that require insurers to sell Medigap on a continuous, year-round guaranteed-issue basis.

Exam trap: A 72-year-old New Yorker with diabetes who missed the federal 6-month window wants to switch Medigap carriers. In most states she could be declined. In New York, she may buy any plan from any carrier at any time, with no underwriting and no waiting period.

Community Rating — No Age Factor

New York requires community rating on Medigap, meaning premium cannot vary by the insured's age. The three rating methods other states use are:

Because New York forbids both issue-age and attained-age rating, an 85-year-old pays the same base rate as a 65-year-old for the identical plan. Premiums can still rise for the whole community due to inflation and claims trends — community rating bars age-based differences, not all increases.

Trade-off to know: New York's open year-round enrollment plus community rating means healthier, younger 65-year-olds in effect subsidize sicker and older enrollees, so New York's base Medigap premiums are among the highest in the nation. The exam may frame this as the price New York pays for its strong guaranteed-issue protections.

Standardized Plan Letters

The federal government standardizes Medigap into plans A through N. New York adopts these letters; carriers choose which to offer but cannot alter the benefits within a letter.

Exam trap: Plans C and F include the Part B deductible. The MACRA rule closed them to anyone newly eligible for Medicare on or after January 1, 2020. Someone eligible before that date may still buy or keep C or F. New eligibles default to Plan G as the comprehensive option.

Additional Guaranteed-Issue Triggers

Even beyond continuous open enrollment, federal guaranteed-issue rights protect beneficiaries who:

1. Lose employer or union group health coverage that paid after Medicare.
2. Are in a Medicare Advantage plan that leaves their area or is terminated.
3. Use the Medicare Advantage trial right — first-time MA enrollees may return to Medigap within 12 months.

Producer Conduct Rules

Selling Medigap in New York carries strict market-conduct duties:

• Hold an accident and health (A&H) producer license.
• Never sell Medigap to a person enrolled in Medicaid — it would duplicate coverage the consumer already has.
• Do not sell a duplicate Medigap policy; replacing one requires a signed replacement notice.
• Provide the "Choosing a Medigap Policy" buyer's guide and the Outline of Coverage at or before application.
• Document suitability and avoid high-pressure or misleading tactics aimed at seniors.

Worked example: A producer meets a 67-year-old who already owns Plan G and is also dual-eligible for Medicaid. Selling him a second Medigap plan would be an illegal duplicate sale, and selling any Medigap to a Medicaid recipient is prohibited. The correct action is to decline the sale and explain why.