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    v1.0.30
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyIdaho Medicare Supplement Coverage Update | OpenPa…
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    CurrentIdaho Department of InsurancePolicy 23-04

    Medicare Supplement Guaranteed Issue Eligibility

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    This bulletin directs insurers offering Medicare supplement policies in Idaho to guarantee issue for certain applicants affected by Medicaid continuous coverage and delayed Medicare Part B enrollment. It establishes eligibility, application timing, documentation, and nondiscrimination requirements.

    Policy Summary
    PayerIdaho Department of Insurance
    PolicyMedicare Supplement Guaranteed Issue Eligibility
    Policy CodePolicy N/A
    Change TypeOperational eligibility guidance
    Effective DateMarch 22, 2023
    Next Review DateN/A
    Key ActionGuarantee issue of any Medicare supplement policy available in Idaho to applicants who satisfy the Medicaid and Medicare Part B eligibility conditions.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    4Eligibility conditions applicants must satisfy
    63 daysApplication period after Medicaid termination or disenrollment notice/date
    6 monthsAlternative application period following initial Medicare Part B enrollment
    90 daysContinuation period after related Medicaid redeterminations and disenrollments
    Policy Summary
    PayerIdaho Department of Insurance
    PolicyMedicare Supplement Guaranteed Issue Eligibility
    Policy CodePolicy N/A
    Change TypeOperational eligibility guidance
    Effective DateMarch 22, 2023
    Next Review DateN/A
    Key ActionGuarantee issue of any Medicare supplement policy available in Idaho to applicants who satisfy the Medicaid and Medicare Part B eligibility conditions.
    SourceLink
    On This Page
    Special Medicare Supplement Guaranteed Issue EligibilityApplication Windows and Continuation PeriodInsurer and Application-Processing RequirementsKey Terms

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    IdahoState jurisdiction

    Special Medicare Supplement Guaranteed Issue Eligibility

    Special Medicare Supplement Guaranteed Issue Eligibility

    Insurers writing Medicare supplement policies must guarantee issue of any Medicare supplement policy available in Idaho to applicants who satisfy ALL eligibility, timing, and documentation requirements below.

    ALL of the following

    • The applicant is enrolled in Medicare Part B while enrolled in medical assistance under Title XIX of the Social Security Act (Medicaid).

    • ONE of the following Medicaid coverage circumstances

      • The applicant remained enrolled in Medicaid because Medicaid terminations were suspended during a state of emergency and was not disenrolled or terminated until at least six months after the effective date of Medicare Part B enrollment.
      • The applicant enrolled in Medicare Part B for the first time upon termination of the temporary Medicaid continuous coverage.

    • ONE of the following application windows

      • The applicant applies during the 63-day period following the later of the notice of termination or disenrollment from Medicaid or the date of termination from Medicaid.63 days
      • The applicant applies during the six-month period following the first day of the first month in which the applicant is enrolled in Medicare Part B.6 months
    • The applicant submits evidence of the date of termination or disenrollment from Medicaid with the Medicare supplement application.

      The insurer must guarantee issue of any Medicare supplement policy it offers and makes available for issuance to new enrollees.

    For applicants covered by this special guaranteed-issue protection, Idaho prohibits insurers from using a preexisting condition to deny or condition issuance or effectiveness of an available Medicare supplement policy, discriminate in pricing because of health status, claims experience, receipt of health care, or medical condition, or exclude the applicant from receiving benefits.

    These protections apply under IDAPA 18.04.10.41; applicants typically apply within six months of the first day of the first month in which they are eligible for Medicare and enrolled in Medicare Part B.

    This Bulletin remains in effect until 90 days after the Idaho Department of Health and Welfare completes all redeterminations and disenrollments related to temporary Medicaid continuous coverage.

    Bulletin No. 23-04 is an agency interpretation of existing law, not new law, except as authorized by law or incorporated into a contract.

    Application Windows and Continuation Period

    Application window after Medicaid termination or disenrollment
    Application window63 days
    Timing ruleThe period follows the later of the applicant’s Medicaid termination or disenrollment notice or the date of termination or disenrollment.
    Applicable eventTermination or disenrollment from Medicaid
    Application window after Medicare Part B enrollment
    Application windowSix months
    Starting pointThe first day of the first month in which the applicant is enrolled in Medicare Part B.
    Applicable enrollment

    Insurer and Application-Processing Requirements

    Note

    Guarantee Issue for Qualifying Applicants

    Insurers writing Medicare supplement policies in Idaho must guarantee issue any Medicare supplement policy available in the state to applicants who satisfy all applicable bulletin criteria.

    Note

    Qualifying Medicaid and Part B Status

    The applicant must be enrolled in Medicare Part B while enrolled in Medicaid under Title XIX. The applicant must have remained on Medicaid because emergency-related termination suspensions continued coverage until at least six months after Part B enrollment became effective, or must have enrolled in Part B for the first time when temporary Medicaid continuous coverage ended.

    Billing Rule

    Application Timing

    Key Terms

    Medicaid
    ProgramMedical assistance provided under Title XIX of the Social Security Act.
    Program nameMedicaid
    RelevanceMedicaid enrollment is part of the eligibility conditions for the special Medicare supplement guaranteed issue opportunity.
    Medicare Part B
    ProgramThe federal Medicare medical insurance program.
    Enrollment relevanceMedicare Part B enrollment establishes qualifying guaranteed issue eligibility and application timing under the bulletin.
    Timing reference
    Initial Medicare Part B enrollment used to establish eligibility for the Medicare supplement policy.
    Bulletin continuation period
    Continuation periodUntil 90 days after Idaho Health and Welfare completes all related redeterminations and disenrollments.
    Responsible agencyIdaho Health and Welfare
    Related activityRedeterminations and disenrollments associated with temporary Medicaid continuous coverage.

    Accept an application during the applicable special enrollment window: generally, within 63 days after the later of the applicant’s Medicaid termination/disenrollment notice or actual termination date. An alternative window is the six-month period beginning on the first day of the first month in which the applicant is enrolled in Medicare Part B.

    Documentation Required

    Termination or Disenrollment Evidence

    Require applicants to submit evidence of the date they were terminated or disenrolled from Medicaid with the Medicare supplement application.

    Denial Risk

    No Preexisting-Condition Discrimination

    Insurers may not use a preexisting condition or health status to deny or condition issuance or effectiveness, vary pricing, or exclude applicants from benefits for an otherwise available Medicare supplement policy. This prohibition includes discrimination based on claims experience, receipt of health care, or medical condition.

    The applicable six-month period begins on the first day of the first month in which the applicant is enrolled in Part B.
    Guaranteed issue
    MeaningA Medicare supplement policy that an insurer must issue to a qualifying applicant.
    AvailabilityThe requirement applies to any Medicare supplement policy available for issuance in Idaho.
    Underwriting limitIssuance may not be based on prohibited health-status or preexisting-condition factors.
    Preexisting condition
    MeaningA health condition or medical history of the applicant.
    Prohibited useIt may not be used to deny or condition issuance or effectiveness of a Medicare supplement policy.
    Other restrictionsIt may not be used to discriminate in pricing based on health status, claims experience, receipt of health care, or medical condition, or to exclude qualifying applicants from benefits.