3.2 South Carolina Medicare Supplement Regulations

The 6-Month Open Enrollment Window

Medicare Supplement insurance (commonly called Medigap) fills the gaps in Original Medicare — deductibles, coinsurance, and copayments. South Carolina adopts the federal/NAIC standardized framework, so the rules track national law with SCDOI enforcement.

The single most-tested fact: the Medigap Open Enrollment Period (OEP) lasts 6 months and begins on the first day of the month in which the individual is both age 65 or older AND enrolled in Medicare Part B. It is a one-time window that does not repeat.

Trap: the window is keyed to Part B, not Part A. Someone who has Part A but delays Part B has not started the clock. The OEP also does not restart if the person later switches insurers.

Pre-Existing Conditions During OEP

Even inside open enrollment, a Medigap insurer may impose a pre-existing condition waiting period of up to 6 months for conditions diagnosed or treated in the 6 months before the policy effective date. However, that waiting period must be reduced day-for-day by the months of prior creditable coverage.

Worked example: an applicant had 4 months of qualifying employer coverage immediately before her Medigap plan starts. The insurer may impose at most 6 − 4 = 2 months of pre-existing condition waiting. With 6+ months of continuous prior creditable coverage, the waiting period is eliminated entirely.

Guaranteed-Issue Rights Outside OEP

After the OEP closes, applicants can generally be underwritten — but guaranteed-issue (GI) rights survive in defined situations. The applicant must apply within 63 days of the qualifying event and the insurer must sell on a guaranteed basis with no health-based pricing.

Standardized Plans A Through N

Medigap plans are standardized by letter, so a Plan G from one SC carrier covers the same benefits as a Plan G from another — they compete on price and service, not benefits. This is a favorite exam point.

MACRA closure: Plans C and F pay the Part B deductible ("first-dollar" coverage). Under the Medicare Access and CHIP Reauthorization Act (MACRA), they are closed to anyone first eligible for Medicare on or after January 1, 2020. People already enrolled may keep them, and those eligible before 2020 may still buy them. Today's newly eligible clients steer toward Plan G as the closest comprehensive alternative.

The 30-Day Free Look and Replacement Rules

Every Medigap policy delivered in South Carolina must display a 30-day free look notice in bold type on the first page. The buyer may return the policy within 30 days of delivery for a full premium refund, no questions asked.

Producers must also follow replacement safeguards:

• Deliver the official "Guide to Health Insurance for People with Medicare" at or before application
• Complete a replacement notice when displacing existing coverage
• Avoid selling a client duplicate Medigap coverage — it is an unfair trade practice and a violation that can cost the producer their license

Scenario: an agent sells a healthy 67-year-old (already holding a Plan G) a second Medigap policy. Because federal and SC law bar duplicate Medigap sales, the agent has committed a violation regardless of the client's signature — selling unneeded duplicate coverage is never permitted.

What Medigap Does and Does Not Cover

Producers must clearly separate Medigap from other Medicare products. Medigap supplements Original Medicare (Parts A and B) by paying the cost-sharing Medicare leaves behind. It does not add network coverage, drug coverage, or replace Medicare.

Critical exam trap: it is illegal to sell a Medigap policy to someone enrolled in a Medicare Advantage plan unless they are leaving MA. Medigap and MA do not coordinate — they are mutually exclusive choices. A producer who sells Medigap to an active MA member commits a prohibited sale.

Rating Methods and Suitability

Medigap premiums are priced using one of three rating methods, and a producer must disclose which applies:

• Community-rated (no-age-rated) — everyone pays the same premium regardless of age.
• Issue-age-rated — premium based on age at purchase; does not rise simply because the insured ages.
• Attained-age-rated — premium starts lower but increases as the insured grows older, often the most expensive long-term.

Worked comparison: two 66-year-olds buy the same Plan G. With issue-age rating, the buyer's premium will not increase merely because they turn 75; with attained-age rating, the premium climbs each year with age. Suitability counseling should flag that attained-age plans look cheap at 65 but can become unaffordable later.

Marketing and Disclosure Duties

South Carolina enforces NAIC Medigap marketing rules. Producers must:

• Deliver the "Guide to Health Insurance for People with Medicare" at or before application.
• Use the Medicare Supplement Outline of Coverage to disclose benefits.
• Avoid high-pressure tactics, twisting, and misrepresentation of government affiliation.
• Never imply the policy is endorsed by Medicare or the federal government.

Violations such as selling duplicate or unsuitable coverage are unfair trade practices that the SCDOI can penalize with fines, suspension, or revocation of the producer's license.