The Delaware Department of Insurance reminds residents of a new Medicare “Birthday Rule” and enrollment protections that are in effect.
The new rule and enrollment protections are both as a result of Senate Bill 71 that was implemented earlier this year after being signed into law last September.
The new “Birthday Rule” is a window that allows for plan adjustments without medical hurdles.
"Really it will give Delaware seniors stability to have greater flexibility and protection by establishing what we call a guaranteed enrollment window, which is around the policy holder's birthday. We ensure that they can shop for better rate or more suitable coverage without the fear of being denied for a pre-existing condition," said Delaware Insurance Commissioner Trinidad Navarro.
Carriers are prohibited from using medical underwriting, health status or claims history to deny coverage or increase prices during the Special Enrollment Period.
Navarro says this wasn’t the case before passage of Senate Bill 71 last year.
"Before this bill, they would be subject to being denied for the change in their condition or pre-existing condition,” said Navarro. “So this really eliminates that, and so what it does is it gives folks 30 days before their birthday and lasts for at least 30 days after, so it gives you that window."
Policyholders can switch to any Medigap plan during that time with the same or lesser benefits from their current or a different carrier.
The rules apply to state residents who purchased a Medicare Supplement policy and still reside in the state, and out-of-state policyholders who now live in Delaware once carriers are aware of their residency.
For those switching from Medicare Advantage to a Medicare Supplement policy, SB 71 prohibits issuers of Medicare Supplement policies from denying applications, but it does allow issuers to individually rate and apply a pre-existing condition limitation.
