3.2 Tennessee Medicare Supplement Regulations

The Six-Month Medigap Open Enrollment Period

Tennessee follows the federal and NAIC framework for Medicare Supplement (Medigap) insurance. The single most-tested fact is the six-month open enrollment period (OEP). It begins on the first day of the month in which the applicant is both age 65 or older and enrolled in Medicare Part B — and it never resets. During this window the insurer must accept the applicant on a guaranteed-issue basis.

Worked example: A man turns 65 on May 14 and starts Part B June 1. His Medigap OEP runs June 1 through November 30 (six months). If he waits until December to apply, the insurer may use medical underwriting and decline him or charge more — unless a separate guaranteed-issue right applies.

Guaranteed-Issue Situations Outside the OEP

Even after the OEP ends, federal law preserves guaranteed-issue rights in specific circumstances, such as:

• A Medicare Advantage plan leaves the service area or terminates.
• An employer group health plan that paid secondary to Medicare ends.
• The beneficiary's trial right to try Medicare Advantage and switch back within 12 months.
• The insurer becomes insolvent or the beneficiary loses coverage through no fault of their own.

The exam often contrasts these limited guaranteed-issue triggers with the broad guaranteed issue available during the OEP. Memorize that the OEP is the only general, no-questions-asked window.

Pre-Existing Conditions and the Look-Back

During the six-month OEP, an insurer cannot apply a pre-existing condition exclusion at all. Outside the OEP, a Medigap insurer that does accept an applicant may impose a pre-existing condition waiting period of up to six months for conditions treated or diagnosed in the six months before coverage began. This 6-month look-back mirrors the LTC standard discussed in 3.3, so candidates frequently confuse the two — keep them straight by product. If the applicant had prior creditable coverage, that period can shorten or eliminate the waiting period, another point the exam may test.

Standardized Plans A Through N

Medigap benefits are standardized by letter, so a Plan G from one insurer covers the same Medicare gaps as a Plan G from another — only price and service differ. This standardization is the consumer-protection core the exam emphasizes.

Note: Plans C and F (which cover the Part B deductible) are closed to anyone who became newly eligible for Medicare on or after January 1, 2020. Beneficiaries eligible before that date may still buy or keep C or F.

Producer Duties, Replacement, and Anti-Duplication

Tennessee enforces the NAIC Medicare Supplement Insurance Minimum Standards model. Producer obligations the exam tests:

• Outline of coverage must be delivered no later than at policy delivery, summarizing benefits in standardized format so buyers can compare.
• Replacement rules: when replacing existing Medigap or health coverage, the producer must provide a replacement notice and a separate 30-day free look on the new policy; the applicant signs acknowledging the replacement.
• Anti-duplication: it is an unfair trade practice to sell a beneficiary coverage that duplicates benefits they already have. A producer must obtain a signed statement of existing coverage.
• No high-pressure / twisting: agents may not misrepresent a plan to induce a switch (twisting) or churn policies for commission.

Decision rule for tricky questions: when two answers seem plausible, pick the one that gives the beneficiary clearer disclosure and avoids unnecessary replacement or duplication. The regulatory intent is to let buyers compare standardized benefits and protect them from losing coverage they do not understand.

Common traps: confusing the 6-month OEP with the annual Medicare Annual Election Period (which is for Medicare Advantage and Part D, not Medigap); and assuming Medigap covers long-term custodial care — it does not.

Suitability, Advertising, and Free Look

Tennessee's adoption of the NAIC model also imposes suitability and advertising standards specific to Medicare Supplement sales. An insurer must establish marketing procedures to ensure a comparison of policies, must not knowingly sell more coverage than the beneficiary needs, and must train producers on the differences among Medicare Advantage, Part D, and Medigap so beneficiaries are not misled. Advertising materials for Medicare Supplement policies are typically subject to filing with the Commissioner, and using terms that imply the plan is endorsed by the government is prohibited.

Every newly issued Medicare Supplement policy carries a 30-day free look — longer than the 10-day window for ordinary health policies — reflecting how consequential a switch can be for a senior. If the beneficiary returns the policy within 30 days, the insurer must refund the premium. The outline of coverage must be delivered at the time of application or no later than policy delivery, and it must use the standardized format so the buyer can line up benefits across competing carriers.

When an exam question describes an agent who pressures a beneficiary to drop a working plan, omits the replacement notice, or sells a second policy duplicating existing benefits, the correct answer is almost always the one identifying an unfair trade practice and favoring fuller disclosure to the consumer.