Key Takeaways
- Virginia 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
- Virginia allows community rating, issue-age rating, or attained-age rating
- Medicare Supplement plans must be standardized (Plans A through N)
- Virginia prohibits pre-existing condition waiting periods during open enrollment
Virginia Medicare Supplement (Medigap) Regulations
Virginia has adopted protections for Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance.
Open Enrollment Period
Virginia 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
- 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 open enrollment is the best time to buy Medigap because you have guaranteed acceptance regardless of health conditions.
Guaranteed Issue Rights
Beyond open enrollment, Virginia 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 |
| Losing Medicaid | Can purchase Medigap |
Trial Right
If you leave Medigap for Medicare Advantage:
- Have 12 months to decide
- Can return to previous Medigap plan
- Or any plan from same insurer
- Guaranteed issue, no health questions
Standardized Plans
Virginia 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.
Rate Regulation
Virginia allows three types of Medigap rating:
| Rating Method | Description |
|---|---|
| Community Rating | Same rate regardless of age |
| Issue-Age Rating | Rate based on age at purchase |
| Attained-Age Rating | Rate increases as you age |
Rate Filings
- All rate changes must be filed with Bureau
- Bureau reviews for actuarial soundness
- Increases must be justified
Pre-Existing Conditions
During Open Enrollment
- No pre-existing condition exclusions
Outside Open Enrollment
- May apply 6-month look-back period
- Maximum 6-month waiting period
- Credit for prior coverage applies
How long is the open enrollment period for Medicare Supplement in Virginia?
Which Medicare Supplement plans are only available to those who became eligible for Medicare before January 1, 2020?