Key Takeaways
- Pennsylvania requires a 30-day free look period for Medicare Supplement policies
- Pennsylvania requires a 6-month open enrollment period for Medicare Supplement starting at age 65
- Guaranteed issue rights apply when losing other coverage or during open enrollment
- Pennsylvania follows federal standardized Medigap plan rules (Plans A through N)
- Pennsylvania requires insurers to offer Plans A and C (or F for those eligible before 2020)
Pennsylvania Medicare Supplement (Medigap) Regulations
Pennsylvania provides important protections for Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance.
Free Look Period
Pennsylvania provides a 30-day free look period for Medicare Supplement policies:
- Longer than standard health insurance (10 days)
- Can return for full premium refund
- Begins when policy is delivered
- Applies to all Medigap plans
Open Enrollment Period
Pennsylvania provides a 6-month open enrollment period for Medicare Supplement:
When It Begins
The 6-month period starts:
- First day of the month you are 65 or older AND
- Enrolled in Medicare Part B
Protections During Open Enrollment
- Guaranteed issue - Must be accepted regardless of health
- No pre-existing condition exclusions (though waiting periods may apply)
- Standard rates - Cannot be charged more for health conditions
- Any plan available - Can choose any Medigap plan A through N
Exam Tip: The 6-month Medigap open enrollment begins when you're both 65+ AND enrolled in Part B. Both conditions must be met.
Guaranteed Issue Rights
Beyond open enrollment, Pennsylvania provides guaranteed issue rights in specific situations:
Triggering Events
| Event | Guaranteed Issue Right |
|---|---|
| Losing employer coverage | Can purchase Medigap within 63 days |
| Leaving Medicare Advantage | Can return to Medigap within 63 days |
| Medicare Advantage plan leaves area | Can purchase Medigap |
| Medigap insurer becomes insolvent | Can switch to comparable plan |
| Medicare SELECT plan changes network | Can purchase standard Medigap |
Standardized Plans
Pennsylvania requires Medigap plans to be standardized according to federal rules:
Available Plans
| Plan | Benefits |
|---|---|
| Plan A | Basic benefits only |
| Plan B | Basic + Part A deductible |
| Plan C | Comprehensive (pre-2020 eligibility only) |
| Plan D | Similar to C, no Part B excess |
| Plan F | Most comprehensive (pre-2020 eligibility 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.
Required Plan Offerings
Pennsylvania requires insurers selling Medigap to offer:
- Plan A (core benefits)
- Plan C or Plan F (if applicant was eligible before 2020)
Pre-Existing Condition Provisions
Pennsylvania allows a pre-existing condition waiting period:
| Situation | Waiting Period |
|---|---|
| During Open Enrollment | Maximum 6 months |
| With Prior Creditable Coverage | Reduced by prior coverage |
| Guaranteed Issue | Cannot apply |
Credit for Prior Coverage
If you had prior health coverage:
- Waiting period reduced day-for-day
- Must have been covered in previous 63 days
- Continuous coverage required for full credit
Rate Regulation
Pennsylvania Medigap rate rules:
- Attained age rating permitted (premiums increase with age)
- Issue age rating also permitted
- Community rating not required by state
- Rate increases must be filed with PID
How long is the free look period for Medicare Supplement policies in Pennsylvania?
How long is the open enrollment period for Medicare Supplement in Pennsylvania?