Insurance Regulatory Insights

TX

HB2516

Approved

Effective:

June 20, 2025

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 end-stage renal disease or 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 during:

1) 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, discriminate in pricing, or impose a waiting period or pre-existing condition limitation.

This act applies to Med Supp plans delivered, issued for delivery, or renewed on or after September 1, 2025.

MN

HF4

Approved

Effective:

August 1, 2026

1) Creates a new GI situation that allows individuals aged 65 to 70 who want to enroll in a Med Supp policy outside of their initial OE period to enroll during the Medicare annual OE period without medical underwriting or preexisting condition limitations. The individual may only make this choice once during ages 65 to 70. For these individuals, the GI period is the Medicare annual OE period. A penalty applies to individuals who enroll in this manner. The penalty is a 15% addition to premiums and any standard increases in community rate for those who enroll during OE of 2026, and it increases 5% per year, with a maximum penalty of 35% applying for OE 2029 into the future. The penalty will apply for the duration of the policy. Also prohibits insurers from applying a pre-existing condition treatment waiting period for reinstated policies if the enrollee qualifies for the penalty.

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

3) Reinstates statutory Replacement Notice disclosure language from 2022 related to medical underwriting and preexisting condition coverage.

WY

Bulletin

06-2025

New

If an individual voluntarily terminates enrollment in a Med supp after June 1, 2025, and enrolls in another Med supp policy, the GI period begins on the individual's birthday and ends sixty-three (63) days after. The individual is eligible for any comparable or lesser Med supp policy offered by any issuer. The state also provided a resource sheet showing plan selection options based on the current policy.

CMS

CMS Bulletin (6/18/2025)

New

Provides Contract Year (CY) 2026 agent and broker compensation rates, referral/finder’s fee amounts, directions for submitting rates and amounts into the HPMS, as well as guidance on for MA plans and Part D sponsors for developing training and testing.

NH

Bulletin

INS 25-038-AB

New

Signing an insurance application as “producer of record” when said producer has no knowledge of or has had no interaction with the consumer is a violation of NH law and may result in administrative penalties including fines and license suspension or revocation.

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.

RI

S0610 / H5494

Movement

The health insurance commissioner shall evaluate adopting a community rating structure for Med Supp plans, and report/file finding and recommendations on or before 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 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 beginning from the individual's Medicare Initial Enrollment Period (IEP), will be afforded GI rights for any Med supp policy available in the state, annually during the Medicare Annual Enrollment Period (AEP) for coverage effective January 1 of the following year.

State

Bill/Notice Number

Status

Summary

Congress

HR3467

Movement

For plan years beginning on January 1, 2028 and after, reforms Medicare Advantage 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 Medicare Advantage 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

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

IL

HB0035

Movement

Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides the Department of Insurance regulatory oversight of insurer's use of AI systems to make or support adverse determinations.