Changes have been made to Kentucky’s Medicare supplement (Medigap) plans that may affect those in the state enrolled in the program. Starting in 2024, Kentucky has implemented the “birthday rule” for Medigap insurance plans. The birthday rule change allows those with a Medigap plan to switch insurance carriers yearly without undergoing medical underwriting. Also, some Kentuckians under age 65 may qualify for guaranteed-issue Medicare supplement plans. See what these changes may mean for your coverage.
What is the Kentucky Medicare supplement birthday rule?
The Medigap birthday rule in Kentucky allows someone already enrolled in Medigap to change to a new insurer every year around their birthday with guaranteed acceptance. This new rule went into effect on January 1, 2024.
Typically, if you want to enroll in or switch Medigap plans after your open enrollment period ends and don’t qualify for a guaranteed issue right, you may have to answer questions about your medical history. This is called medical underwriting. When you’re subject to medical underwriting, insurance companies look at your health risk to decide if they’ll accept your application and determine how much you should pay in premiums. They can deny coverage or increase premiums if you have pre-existing health conditions.
With Kentucky’s new birthday rule, the barrier of medical underwriting is eliminated if you currently have a Medigap plan and wish to make changes. You can now switch to another insurance carrier’s Medicare supplement plan within 60 days of your birthday without medical underwriting.
It’s important to understand that you must switch to the same lettered plan if you decide to change your Medigap insurance company under Kentucky’s new birthday rule. For example, if you currently have a Medicare Supplement Plan G, you can shop for different insurance carriers during your 60-day birthday enrollment window, but you may only switch to their version of Plan G.
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How does the Kentucky Medicare supplement birthday rule work?
To take advantage of Kentucky's new Medicare supplement birthday rule, you must meet a few criteria. Here’s how it works:
First, you must already be enrolled in a Medicare supplement insurance plan to qualify.
Next, you have a 60-day enrollment window that opens on your birthday each year to submit your application to a new insurance company. Your enrollment period using the birthday rule will depend on your birth date. For example, if your birthday is March 15th, you can apply no later than May 14th (60 days from March 15th).
While you can select a new insurance company, your supplemental coverage and lettered plan must remain the same when you switch. For example, if you currently have an Aetna Medicare Supplement Plan G policy under the birthday rule, you can only switch to another carrier’s plan G (like Cigna Medicare Supplement Plan G).
If you meet the criteria above, coverage is guaranteed. This means during these 60 days, a Medigap insurance provider cannot deny you coverage. The insurance provider cannot charge you higher premiums because of pre-existing health conditions, current health status, or medical history.
Who qualifies for the Kentucky Medicare supplement birthday rule?
To be eligible for the birthday rule provisions in Kentucky allowing Medigap plan changes, you must meet the following criteria:
- Current Medigap enrollee. You already have an active Medicare supplement insurance policy from a private carrier.
- Kentucky resident. You live in the state of Kentucky.
How is the Kentucky Medigap birthday rule helpful?
Kentucky’s new Medigap birthday rule lets you shop yearly for a new Medicare supplement insurance provider. As of 2024, 43 insurers are offering Medicare supplement plans in Kentucky. Since you can switch policies during the 60-day enrollment window, you can compare what carriers charge for the same Medicare supplement plan you already have. This means you can potentially save money on premium costs.
For example, using the guaranteed-issue 60-day window around your birthday to compare plan pricing could allow you to switch from an expensive policy to a more affordable option with the same lettered benefits. So, it’s helpful to take the time each year around your birthday to get quotes and check rates from competitors.
How can I change insurance carriers under the supplement birthday rule?
If you want to take advantage of the new Kentucky Medicare supplement birthday rule to adjust your supplemental coverage, follow these steps:
- Contact the new insurance carrier you wish to have coverage with during your 60-day enrollment window and request an application.
- Fill out the application for the same lettered Medigap plan you currently have.
- If you meet the criteria, the Medicare supplement insurance company, by law, must approve your application for coverage without increasing your premiums for pre-existing conditions.
- Verify that the new insurance carrier's pricing structure meets your needs before finalizing a change.
- Check with the insurer when the new policy will be effective.
- Notify your existing Medigap provider that you plan to terminate your coverage. Make sure there are no gaps between when one plan ends and the next begins.
If you need help switching insurance carriers using the birthday rule or have questions, contact the Kentucky State Health Insurance Assistance Program (SHIP). Their trained counselors offer free information and support to older people and those with disabilities.
What has changed in Kentucky for people under age 65 with Medicare?
Under the new legislation, Kentucky has new rules to make it easier for people under 65 on Medicare to qualify for guaranteed-issue Medicare supplement plans. This rule is effective January 1, 2024.
In the past, Kentuckians under 65 with Medicare had to undergo medical underwriting to enroll in a Medigap plan. Now, Kentucky requires that insurance companies offer Medigap guaranteed-issue coverage to Medicare recipients under 65 who apply within six months after their Medicare coverage starts. This means you cannot be denied Medigap coverage if you meet the criteria, and the insurer cannot impose a waiting period.
Additionally, insurance carriers cannot charge higher premium rates to those under 65 because of age or health status.
When do I qualify for guaranteed-issue coverage for supplement plans?
There are a few instances when insurance companies must sell you a Medicare supplement insurance plan in Kentucky, regardless of your health conditions. This is called guaranteed-issue coverage.
- If you are under 65 and enrolled in Medicare, you can apply for a Medigap plan within six months after your Medicare coverage starts.
- If you meet the birthday rule qualifications, you have 60 days from your birthday date to switch carriers.
- When anyone in Kentucky applies for a Medicare supplement policy within the first six months of turning 65 and enrolls in Medicare Part B on time (without any penalties under federal law).
What does guaranteed issue mean?
Guaranteed issue means health insurance companies must sell coverage to any eligible applicant. Under guaranteed issue, those with pre-existing conditions and chronic illnesses can enroll in health policies for which they may otherwise be denied.
What does Kentucky Medicare cover?
Medicare is a federal program that offers health insurance to people 65 and older and some younger people with disabilities. In every state, including Kentucky, Medicare can help pay for hospital stays, doctor visits, medications, and other medical care. Medicare beneficiaries may opt for additional coverage through Medicare Advantage or Medicare supplement plans.
Is Medicare free in Kentucky?
Medicare is not entirely free in Kentucky. While Medicare Part A is often premium-free for those eligible, people may have to pay premiums, deductibles, copays, and other out-of-pocket costs when enrolled in Medicare.
Starting January 1, 2024, Kentucky’s Medicare supplement birthday rule allows qualified enrollees to switch to a new Medigap insurer each year around their birthday.
Under the new birthday rule in Kentucky, coverage is guaranteed for those who meet the criteria and follow the guidelines.
To take advantage of Kentucky’s new Medigap birthday rule, you must be enrolled in Medigap and request to change to a new insurer within 60 days of your birthday.
You must keep the same lettered Medigap plan when changing insurance providers.
Kentucky’s new birthday rule allows you to compare premiums from different insurance carriers and potentially save money on insurance costs.
- Team Kentucky. Cabinet for Health and Family Services. State health insurance assistance program.