Medigap (Medicare Supplement) special enrollment and birthday rule
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Governance of new special enrollment periods and protections for Delaware Medicare Supplement (Medigap) enrollees created by SB 71, including who is affected and carrier obligations beginning January 1, 2026.
Creates a birthday-rule open enrollment period allowing existing Medigap policyholders a window around their birthday to switch to another Medigap policy without medical underwriting.
Guarantees issuance of Medigap policies to enrollees switching from Medicare Advantage to original Medicare during standard open enrollment periods; issuers cannot deny applications but may individually rate and apply pre-existing condition limitations.
Carriers cannot rate up existing Medigap policyholders who switch under the birthday rule and must charge existing rates to such new policyholders until renewal.
Medigap Enrollment and Issuer Requirements
Medigap enrollment and issuer requirements
Covered when ALL of the following conditions are met:
Enrollment Windows and Coding Notes
| No codes listed |
Enrollment and Underwriting Rules for Issuers
Enrollment and underwriting rules for Medigap birthday-rule and MA transitions
Existing Delaware Medigap policyholders may purchase a new Medigap (Medicare Supplement) policy during a birthday-rule special enrollment period (starting 30 days before and remaining open at least 30 days after the enrollee's birthday) without medical underwriting; carriers must not consider innovative benefits when comparing policies for “same or lesser” benefit tests. Carriers must also accept applications from people who switch from Medicare Advantage to original Medicare during the specified enrollment periods (Oct 15–Dec 7 or Jan 1–Mar 31); issuers may not deny those applications but may individually rate and apply pre‑existing condition limitations.
- Birthday-rule SEP: 30 days before through at least 30 days after the enrollee's birthday; allows purchase without medical underwriting (same or lesser benefits only).
- Innovative benefits must be excluded when comparing benefit parity.
- For enrollees switching from Medicare Advantage during Oct 15–Dec 7 or Jan 1–Mar 31, issuers may not deny applications but may individually rate and apply pre-existing condition limitations.
Key Terms
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