Key Takeaways
- New York has permanent open enrollment for Medicare Supplement - guaranteed issue all year
- New York is a community-rated state for Medigap - rates cannot increase based on age
- Guaranteed issue rights apply anytime, not just during initial enrollment period
- New York prohibits pre-existing condition waiting periods for Medigap
- Medicare Supplement plans must be standardized (Plans A through N)
New York Medicare Supplement (Medigap) Regulations
New York has the most consumer-friendly Medicare Supplement (Medigap) regulations in the country. New York provides protections that go far beyond federal requirements.
Permanent Open Enrollment
Unlike most states, New York provides year-round guaranteed issue for Medicare Supplement:
How It Works
- Medicare beneficiaries can purchase Medigap anytime
- No health underwriting required
- Cannot be denied coverage
- Cannot be charged more due to health conditions
- No waiting periods for pre-existing conditions
Comparison to Other States
| Feature | New York | Most States |
|---|---|---|
| Open Enrollment | Year-round | 6-month initial period only |
| Guaranteed Issue | Always | Only during specific times |
| Health Underwriting | Never | Outside open enrollment |
| Pre-existing Waiting | Never | Up to 6 months possible |
Exam Tip: New York's permanent open enrollment is unique. In most states, if you miss the initial 6-month open enrollment, you can be denied coverage or charged more. New York protects consumers year-round.
Community Rating
New York requires community rating for Medigap policies:
What This Means
- Premiums are the same for everyone regardless of age
- A 65-year-old pays the same as an 80-year-old
- Rates cannot increase as you get older
- Based on plan benefits, not individual characteristics
Rating Types (Most States Allow All Three)
| Rating Type | Description | NY Allows? |
|---|---|---|
| Community Rating | Same rate for all ages | Yes (required) |
| Issue Age Rating | Rate locked at purchase age | No |
| Attained Age Rating | Rate increases with age | No |
New York ONLY allows community rating, providing the most predictable premiums.
Standardized Plans
New York requires Medigap plans to be standardized:
Available Plans
| Plan | Benefits |
|---|---|
| Plan A | Basic benefits only |
| Plan B | Basic + Part A deductible |
| Plan C | Comprehensive (pre-2020 only) |
| Plan D | Similar to C, no Part B excess |
| Plan F | Most comprehensive (pre-2020 only) |
| Plan G | Like F without Part B deductible |
| Plan K | 50% cost sharing, out-of-pocket max |
| Plan L | 75% cost sharing, out-of-pocket max |
| Plan M | 50% Part A deductible |
| Plan N | Cost sharing, copays for visits |
Note: Plans C and F are only available to those eligible for Medicare before January 1, 2020.
Guaranteed Issue Rights
In addition to permanent open enrollment, New York provides additional protections:
When Guaranteed Issue Applies Everywhere
| Event | Protection |
|---|---|
| Any time | Can purchase any plan from any insurer |
| Losing employer coverage | Can purchase without underwriting |
| Leaving Medicare Advantage | Can return to Medigap |
| Plan discontinued | Can switch to comparable plan |
No Pre-Existing Condition Waiting Periods
- New York prohibits waiting periods entirely
- Coverage effective immediately
- No exclusion for ongoing treatments
- Full benefits from day one
Producer Requirements
When selling Medicare Supplement in New York:
- Must be licensed for accident and health insurance
- Cannot sell policies to those with Medicaid coverage
- Must explain all plan options available
- Cannot pressure or mislead Medicare beneficiaries
- Must document suitability of recommendation
What makes New York's Medicare Supplement open enrollment unique?
What type of rating does New York require for Medicare Supplement policies?