Key Takeaways
- Washington 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
- Washington prohibits pre-existing condition waiting periods during open enrollment
- Medicare Supplement plans must be standardized (Plans A through N)
- Washington has additional guaranteed issue rights beyond federal minimums
Washington Medicare Supplement (Medigap) Regulations
Washington has adopted protections for Medicare beneficiaries purchasing Medicare Supplement (Medigap) insurance, including open enrollment and guaranteed issue rights.
Open Enrollment Period
Washington 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
Key Points
| Item | Requirement |
|---|---|
| Duration | 6 months |
| Trigger | Age 65 + Part B enrollment |
| Health Underwriting | Prohibited during OE |
| Plan Choice | Any available plan |
Exam Tip: The 6-month open enrollment period is a federal requirement that Washington enforces. It begins when you turn 65 AND enroll in Medicare Part B.
Guaranteed Issue Rights
Beyond open enrollment, Washington 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
Washington 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
Washington has specific Medigap rate rules:
- Attained age rating permitted (premiums increase with age)
- Issue age rating also permitted
- Community rating not required but some insurers offer it
- Rate increases must be filed with OIC
Washington-Specific Protections
Washington provides additional protections:
- Extended guaranteed issue in certain situations
- Consumer assistance through SHIBA (Statewide Health Insurance Benefits Advisors)
- Rate review by OIC
- Complaint investigation
How long is the open enrollment period for Medicare Supplement in Washington?
Which Medicare Supplement plans are NOT available to those who became Medicare-eligible after January 1, 2020?