Insurance Regulatory Insights

MD

SB956

Approved

Effective:

October 1, 2025

For policies issued in the OE period during the 30 days following the birthday of an individual enrolled in a Med Supp policy (§ 15–909(B)(6)) or to an individual at least 65 years old, a carrier shall pay the same commission rate to an insurance producer for the sale of Med Supp policy without regard to whether the policy is sold during an OE period, as an underwritten policy, or under the Birthday Rule.

VT

HO137

Approved

Effective:

January 1, 2026

Allows the Department of Insurance to post rate increase information to their website and seek public comment.

Changes percent of composite average rate increase from 3% to 10%, where the Commissioner will notify the Department of Disabilities, Aging, and Independent Living and the Office of the Health Care Advocate of the proposed premium increase, if a comparable impact is determined and has plan 5,000+ total lives. For plans that exceed 10%, the Commissioner will solicit public comment and hold a public hearing.

For Med Supp policies with January 1 effective date, carriers must file premium rates requests no later than July 1 of the preceding year. For effective dates other than January 1, the carrier must file no later than 6 months prior to the effective date.

WA

SB5351

Approved

Effective:

July 27, 2025

A dental only plan offered by a carrier may not deny coverage for procedures solely on the basis that the procedures were performed on the same day.

Dental only plans will be required to submit information to the commissioner, including members, revenue, payments, and dental loss ratio, annually before April 1 for the preceding year, based only on Washington data. 

MT

SB335

Approved

Effective:

June 1, 2025

Dental insurers shall file an annual statement of dental loss ratio annually by March 1. The Commissioner will develop an average loss ratio and identify outliers. For outlier plans, the carrier shall provide a rebate to the policyholder before August 1 of the fiscal year following the year for which the ratio described.

CONGRESS

HR3467

New

For plan years beginning on January 1, 2028 and after, reforms MA program by:
-requiring payment for benefits on a capitated basis
-reducing the blended benchmark amount
-revising risk adjustments for health status
-nonapplication of quality benchmark increases to qualified MA plans
-establishing stop-loss payment for MA plans that experience significantly higher expenditures compared to the risk-adjusted expected expenditures of such plans
-requiring automatic enrollment (with option to opt out) of each individual entitled to benefits under part A and enrolled under part B into the MA plan with the lowest premium available to such individual
-requiring mandatory continuous enrollment for a 3-year period

PA

HB1325

New

Annual loss ratio report required by April 30 with information for the prior calendar year.  Provides requirements for calculation

LA

Directive 227

New

Requires health insurance issuers submitting a Med Supp annual refund filing to utilize a excel template entitled “Refund Filing Template.”

OR

Bulletin DFR 2025-5

New

Provides guidance on filing rates and forms with the Division of Financial Regulation (DFR).

MD

Bulletin 25-8

New

Due to a declared state of emergency, the Maryland Insurance Administration requires insurers to provide reasonable accommodations, including a 60-day grace period for premium payment, for policyholders that reside in Allegany and Garrett County.

CA

SB242

Movement

Proposed bill making Med Supp plans available to otherwise qualified applicants who are under 65 and have ESRD. 

Also requires a 90-day OE period beginning January 1 each year for any Med Supp plan available from an issuer. Premium rates offered to applicants during the open enrollment period may vary based on the applicant’s age at the time of issue, but shall not vary based on the applicant’s attained age or actual age after the contract is issued. Age-based premiums shall be structured within specified age bands and no additional age bands shall be permitted.

DE

SB71

Movement

1) Insurers must offer Med Supp policyholders an annual OE period beginning 30 days prior to the individual's birthday and ending 30 days after, where the individual can purchase any policy made available by any insurer that offers the same or lesser benefits as the current coverage. The issuer may not deny or condition the issuance or discriminate in pricing based on health status or claims history and may not impose exclusions based on a pre-existing condition.

Insurers must notify individuals at least 30 days but no more than 60 days prior to the commencement of this annual open enrollment period, and include:
-dates on which the OE period begins and ends
-any modification of benefits or adjustment of premiums for current policy

2) A person enrolled in a MA plan may cancel their existing plan and enroll in a Med Supp policy during Medicare OE periods. The issuer may not deny or condition the effectiveness of the Med Supp policy being offered. The issuer is not prevented from individually rating each applicant or applying a pre-existing condition limitation.

MN

SF2498 / HF2403

Movement

1) Provides that upon reinstatement, after suspension based on entitlement to medical assistance, there is no additional waiting period with respect to treatment of pre-existing conditions.

2) Pre-existing limitations shall appear as a separate paragraph of the​ policy or certificate and be labeled as "pre-existing condition limitations."

3) Revises Replacement Notice language.

4) Repeals Minnesota Statutes 2024, sections 62A.3099, subdivision 18b; and 62A.31, subdivision​ 13.21 1w, related to an Open Enrollment Period.

OR

SB1181

Movement

Prohibits denial of a Med Supp insurance policy due to a preexisting condition and charging different rates based on health status, claims experience, and medical condition:

1) Prior to or during the 6-month period beginning with the first day of the month the individual enrolled in Medicare Part B; or

2) during an annual 60-day open enrollment period that begins January 1 each year.

RI

S0610

Movement

Prohibits the use of gender, attained-age, or issue-age rating structures for Med Supp policies issued after January 1, 2026, enforcing community rating as the sole methodology. Individuals with existing policies that utilize the now-prohibited rating structures will be allowed to maintain their current coverage or switch to new policies starting January 1, 2026.
 
Removes previous provision of guaranteed issue rights during an annual enrollment period, replacing with:

1) a 6-month OE period for individuals U65 who qualify for Medicare due to disability or ESRD upon reaching 65;

2) U65 individuals enrolled in a MA plan or Med Supp Plan A due to disability or ESRD have GI rights for any Med Supp Plan A made available in the state;

3) Individuals who have been covered by a Med Supp policy or MA plan with no gaps in coverage greater than 90 days will be afforded GI rights annually during the Medicare Annual Enrollment Period (AEP).

TX

SB1945 / HB2516

Movement

An entity that offers coverage under a Med Supp plan to individuals over 65 must offer the same coverage to individuals under 65 who are eligible for and enrolled in Medicare by reason of amyotrophic lateral sclerosis.

A standardized Plan A, Plan B, or Plan D Med Supp benefit plan must be offered at the same premium rate charged for the plan to an individual 65 years of age. A premium rate for a Med Supp benefit plan, other than Plan A, Plan B, or Plan D, may not exceed 200% of the premium rate charged for the same plan to an individual 65 years of age.

Eligible individuals may enroll:

(1) during the six-month period beginning the first day of the first month the individual becomes enrolled for benefits under Medicare Part B;

(2) a one-time OE period between December 1, 2025 and June 1, 2026, or if unable to submit during this time period because the application is not available when requested, a 6- month period beginning on the date the application becomes available.

During an enrollment period, the entity may not deny or condition the effectiveness, medically underwrite, or impose a waiting period or pre-existing condition limitation.

State

Bill/Notice Number

Status

Summary

NH

SB121

Movement

Any licensed insurance company offering Medicare Advantage Plans in the state should provide 120 days' written notice to the commissioner when modifying or terminating its contract with CMS by mutual consent pursuant to 42 CFR 422.508, ceasing to offer MA plans in a particular county, or significantly modifying the offerings of its MA plans. 

State

Bill/Notice Number

Status

Summary

MO

HB439

Movement

Proposed bill outlining dental loss ratio calculation and annual reporting requirements. The loss ratio report should be filed by March 1 every year for the previous calendar year. Dental plans shall provide annual rebates to enrollees by August 1 of the year following the applicable plan year if the dental loss ratio is less than 85%.