3.2 Virginia Medicare Supplement (Medigap) Regulations

What Medigap Is

Medicare Supplement (Medigap) insurance is private coverage that fills the gaps in Original Medicare (Parts A and B) — deductibles, coinsurance, and copays. It does not work with Medicare Advantage; you cannot legally hold both at once. Plans are standardized federally and lettered A through N, so a Plan G from one Virginia carrier covers exactly the same benefits as a Plan G from another — only the premium differs.

Open Enrollment Period

The Medigap Open Enrollment Period (OEP) is a 6-month window that begins the first day of the month in which the beneficiary is both age 65 or older AND enrolled in Medicare Part B. This window is the single most powerful consumer protection in Medigap:

• Guaranteed issue — the carrier must accept the applicant regardless of health.
• No pre-existing condition exclusion (if the applicant had prior creditable coverage).
• No health-based rate-up — the applicant pays the same rate as a healthy person.
• Any plan A–N offered in Virginia may be chosen.

Exam tip: OEP is age-65-Part-B triggered and one-time. Miss it, and outside a guaranteed-issue trigger the carrier can medically underwrite and decline you. Distinguish it from Medicare's Part B enrollment period — different clocks.

Virginia Birthday Rule (Effective July 1, 2025)

Virginia joined the small group of states with an annual Birthday Rule. Each year, within 60 days following the enrollee's birthday, a current Medigap policyholder may switch to a Medigap policy with equal or lesser benefits from any carrier without medical underwriting — guaranteed issue, no health questions. This lets seniors shop for a lower premium annually without risking a decline. The replacement plan must offer the same or fewer benefits than the existing one; you cannot use the Birthday Rule to upgrade into richer coverage.

Federal Guaranteed-Issue Triggers

Outside OEP, federal law still grants guaranteed-issue rights in defined situations — Virginia mirrors these. The recurring number to memorize is 63 days:

The trial right is the classic exception: a beneficiary who tries Medicare Advantage for the first time may return to a Medigap plan within 12 months, guaranteed issue.

Standardized Plans A–N

Closed-plan rule: Plans C and F pay the Part B deductible, a benefit federal law removed for those newly eligible on or after January 1, 2020. Anyone who turned 65 before that date can still buy C or F; newer beneficiaries cannot. Plan G is the modern comprehensive choice.

Rate Regulation and Pre-Existing Conditions

Virginia permits three rating methods, all of which must be filed with the Bureau of Insurance:

During OEP there is no pre-existing condition exclusion. Outside OEP, a carrier may impose up to a 6-month look-back/waiting period, reduced by months of prior creditable coverage.

Buyer's Guide, Replacement, and Suitability

Virginia requires that a Medigap applicant receive an outline of coverage and the federal "Choosing a Medigap Policy" Buyer's Guide at or before application. When a sale replaces existing Medigap or health coverage, the producer must deliver a replacement notice and the application must disclose the existing coverage. Selling a duplicate Medigap policy to someone who already has one — when the new policy does not clearly add value — is a prohibited practice; an agent may not knowingly sell a beneficiary more Medigap coverage than they can use.

Medicare Advantage enrollees generally should not be sold Medigap, because Medigap does not pay Medicare Advantage cost-sharing. A producer who sells Medigap to a Medicare Advantage member, knowing they intend to keep the Advantage plan, has made an unsuitable sale.

Putting the Numbers Together

The three numeric anchors students confuse most:

• 6 months — length of the one-time OEP.
• 63 days — window to exercise most federal guaranteed-issue triggers after losing other coverage.
• 60 days — the annual Virginia Birthday Rule window after the enrollee's birthday.

Worked scenario: A 67-year-old enrolled in a Medigap Plan G wants a cheaper premium. Her OEP closed two years ago, so ordinarily she would face underwriting. Because Virginia's Birthday Rule is in effect, within 60 days after her birthday she can move to another carrier's Plan G — equal benefits — guaranteed issue, no health questions. If instead she wanted to upgrade to a richer plan, the Birthday Rule would not protect her and she would have to pass underwriting.