Insurance Regulatory Insights

IN

HB1226

Approved

Effective:

January 1, 2026

Med Supp policyholders, who are at least 65 years of age, are eligible for an annual OE period within 60 days of their birthday, where they can purchase the same lettered, including any variation of the letter, Med Supp plan made available by an issuer different than their current policy. The policy must go into effect on the first day of the month that is at least thirty (30) days after the signature date on the application

ND

HB1481

Approved

Effective:

July 1, 2027

Requires annual dental loss ratio report by April 30 annually for the last calendar year. Provides dental loss ratio should not be less than 75%, and requires an annual refund of excess premium if loss ratio is less than 75%.

DE

SB71

New

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 OE 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.

NJ

AA541

New

The commissioner shall only approve a Med Supp policy if the policy contains provisions that:

1) limit premium increases to once per calendar year; and

2) allow policyholders the option to pay the annual premium in advance.

PA

Data Call

New

Provides workbook for Med Supp Refund Calculation to be used by insurers to submit the required annual refund calculation data to the Department for each individual and group standardized Med Supp benefit plan by May 31 of each year.

UT

Bulletin 2025-5

New

Provides guidance concerning HB258, passed and effective May 7, 2025, which provides an annual OE period within 60 days of an enrollee's birthday.

CMS

CMS-4208-F

New

Final Rule - Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly

CA

SB242

To Committee

Proposed bill making Med Supp plans available to otherwise qualified applicants who are under 65 and have ESRD. Also, would require a 90-day OE period beginning January 1 each year for any Med Supp plan available from an issuer.

IA

HF308

(previously HF70)

To committee

Proposed bill that Med Supp policyholders, including individuals under the age of 65 who qualify for Medicare due to disability, are eligible for a 31-day annual open enrollment period beginning March 1. During the OE period, for at least one Med Supp policy offered and available in the state, issuers are prohibited from using medical underwriting, pre-existing condition exclusions, and discriminating in pricing.

MD

SB956

Returned Passed

For policies issued in the open enrollment 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.

MN

SF2477

To committee

1) Adds that community rating may take into account premium increases in recognition of late enrollment or reenrollment. Premium increase of 10% applied as a flat percentage of premium for an individual who enrolls outside of initial enrollment and is not eligible for GI;

2) Prohibits refusing to renew plan unless enrollee has failed to pay premiums, performed fraud or material misrepresentation, moves out of the area where the issuer operates, or the carrier discontinues the plan, and

3) To discontinue the plan, the carrier must provide written notice to the commissioner no later than May 1 of the year before the date of discontinuance, provide written notice to each enrollee at least 90 days before discontinuance, and offer the individual an option to purchase another currently offered plan on a GI basis.

MN

HF2403

Second Reading

1) Adds that community rating may take into account premium increases in recognition of late enrollment or reenrollment.  Premium increase of 10% applied as a flat percentage of premium for an individual who enrolls outside of initial enrollment and is not eligible for GI;

2) Prohibits refusing to renew plan unless enrollee has failed to pay premiums, performed fraud or material misrepresentation, moves out of the area where the issuer operates, or the carrier discontinues the plan; and

3) To discontinue a plan, the carrier must provide written notice to the commissioner no later than May 1 of the year before the date of discontinuance, provide written notice to each enrollee at least 90 days before discontinuance, and offer the individual an option to purchase another currently offered plan on a GI basis.

MN

SF2216

Second Reading

1) Adds that community rating may take into account premium increases in recognition of late enrollment or reenrollment.  Premium increase of 10% applied as a flat percentage of premium for an individual who enrolls outside of initial enrollment and is not eligible for GI;

2) Prohibits a Med Supp policy or certificate from being sold or issued to an individual outside of the time periods described in subdivision 1h of section 62A.31. The time periods described in that subdivision 1h relate to eligible time periods for enrollment in Med Supp policies without being subject to preexisting condition limitations and are generally tied to the enrollment periods for Medicare Part B plans.

OR

SB1181

To committee

Prohibits denial of a Med Supp insurance policy due to a preexisting condition and charging different rates based on health status, geographic location, claims experience, age, 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 90-day open enrollment period that begins January 1 each year.

RI

S0167 / HB5431

To committee

U65- Individuals enrolled in Medicare Parts A and B would have a GI right to enrollment in any standardized Med Supp Plan A, if enrolled during the designated month-long period.

Over 65- Individuals would have a GI right to enroll in any Med Supp plan during the designated month-long period.

For both situations, the issuance or coverage shall not be conditioned on medical underwriting provided that the applicant, having been enrolled in Medicare Part A and Part B, enrolled in a MA plan under Medicare Part C and remains enrolled when the Med Supp application is submitted.

RI

S0610 / H5494

To committee

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 have a 30-day open enrollment period annually beginning on their birthday for any available Med Supp policy.

RI

S0267 / H5499

Introduced / To committee

Amends the current Med Supp regulation to implement continuous open enrollment rights for individuals eligible for Medicare due to age (65+) or under 65 due to disability or ESRD. Also requires community rating. The Office of the Health Commissioner will conduct an annual review of Med Supp premium rates.

TX

SB1945 / HB2516

To committee

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 disability or ESRD at the same premium rate and without pre-existing condition limitations and medical underwriting if enrolled during:

(1) a one-time OE period between August 31, 2025 and March 2, 2026;

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

(3) a 60-day OE period each year beginning on the date of the individual's birth; or

(4)  a special enrollment period designated by the commissioner.

WV

HB2267

To Governor for Signing

Amends and reenacts, §64-7-1 of the Code of West Virginia, 1931, relating to authorizing the Insurance Commissioner to promulgate a legislative rule relating to Med Supp Insurance.

State

Bill/Notice Number

Status

Summary

NH

SB121

To committee

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. 

RI

S0056 / HB5434

To committee

Bill seeking to protect and expand traditional Medicare while urging the United States Government to pass legislation and for CMS to take administrative action to protect citizens against the Medicare Advantage issues described within the bill.

State

Bill/Notice Number

Status

Summary

MN

HF2334

To committee

Requires annual dental rate filing submission that will be effective the next calendar year. Provides dental loss ratio reporting requirements beginning March 1, 2027. Dental loss ratio should not be less than 85%, and requires an annual refund of excess premium if loss ratio is less than 85%.

MT

SB335

Enrolled

Dental insurers shall file an annual statement of dental loss ratio annually by March 1st. The Commissioner will develop an average loss ratio and identify outliers. For outlier plans, the carrier shall refund the excess premium to its covered individuals/groups before August 1 of the calendar year following the year for which the ratio described.

OK

SB1101

Referred for Engrossment

Proposed bill outlining dental loss ratio calculation requirements. Would require carriers to annually file a dental loss ratio form for the preceding calendar year beginning June 30, 2027.

WA

SB5351

Enrolled

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.