Content starts here
Honored Social Butterfly

WHERE ( Geographically ) Can we buy a Medigap Policy ?

Maybe some of our insurance experts can give me a good answer - a rational one.


Why do we have to buy a Medicap plan in a state where we live or do we?


If I live in Tennessee or wherever why can I not (or maybe I can )  buy a Medigap policy in some other state that perhaps has a more economical rating method?  


Could I buy a Medigap policy out of California or Oregon or somewhere where there is "Birthday Rule" or some other state rule that I might like for my situation?  Do these special state rules apply to the policy or where the person lives?


A Medigap policy can move across geographical borders.


Just curious -

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos

Your policy will be issued based on the address SS has on record.

Bark less. Wag more.
0 Kudos
Honored Social Butterfly

@somarco wrote:

Your policy will be issued based on the address SS has on record.

Thanks -

I understand that they want a person to do it that way but I am asking why -

What if  one actually lives in 2 - 4 places in the US during the year?

After all, traditional Medicare is a National program and you can use it anywhere in any state -

You do not have to change the policy even if you move to another state.


I guess I am really asking why states have any say about where you buy the policy -

why do states make various (state) rules about a Medigap policy like the Birthday Rules in certain states and other type state specific rules.


Guaranteed Renewable as long as one pays their premium - right?!? 


All of this stuff, including coverage availabilty of the disabled, if any,  should be set at the National level.  Seems that all the rules of this type should be at the Federal level just like the coverage.

What am I missing?

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos

I understand that they want a person to do it that way but I am asking why -


This is the way DC works. It does not have to make sense and rarely does.


You buy a plan based on where SS thinks you live. You can only have ONE primary residence. If you are a snow bird, pick one place. You can always change it but that does not entitle you to a new Medigap plan.


PDP, yes, but not Medigap.


If you change your residence your existing plan will follow you. If you want to buy a new plan in your new home you can.


As long as you pass underwriting.


Federal (CMS) rules trump everything. States (like MA) can/did petition CMS to offer their own plans vs the 10 standardized ones. States like CA (birthday rule) and MO (anniversary rule) are free to make their own rules as long as they are not more restrictive than CMS rules.


Everything works that way. Not just insurance.


Guaranteed renewable as long as you pay your premium and the carrier does not go belly up . . . which AFAIK has never happened.


CMS sets rules for Medicare qualifying if you are under 65 but there is no federal requirement regarding U65 Medigap.


Some states require carriers to offer U65 Medigap but that didn't work out so well. Almost no one can afford them so most U65 either buy an MA plan or cruise with OM only.


DC required all carriers writing U65 individual major med to issue policies on a guaranteed issue basis. As a result rates are 3x to 4x (or more) higher than pre-2014. Deductibles and OOP are also 2x or more than pre-2017. Most parts of the country have 3 carriers or less vs 20+ prior to 2014. Almost all U65 plans are now HMO. Very difficult to find a PPO.


If you like your doctor . . . .


If you want to see Medicare go the way of Obamacare keep asking for more hope and change.

Bark less. Wag more.
0 Kudos
Honored Social Butterfly


So let's say that I have the benefit of picking my primary residence address in a state that may have a more lenient rule as far as changing plans without underwriting sometimes down the road - like CA., OR, even Missouri -


so I could use that address as my primary address for my initial enrollment and then move around even changing my primary residence address.  But if I want the option of changing plans without underwriting, would I have to make sure my primary address is then recorded in one of those more lenient rule states in order to make this sanctioned change in my Medigap plan without underwriting?


I understand that (regular) health insurance is regulated by states but they are not National plans like Medicare (and Medigap because of their nature - a gap insurance to Medicare).  Seems like we should be able to pick from a national assortment of Medigap plans - doctors are the same, claims are paid the same with maybe some factor adjustment on providers since health care cost are more locally assessed, coding is the same for claims, the payment from the Medigap plan is based on what Medicare (the national insurer) pays.


It seems strange to me that Medigap is even regulated at all at the state level. 

I bet states cannot regulate any part of national plans associated with FEHB or even large employer plans.

Sorry I am being a pain but this just does not make any sense to me.



It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
Showing results for 
Show  only  | Search instead for 
Did you mean: 
Need to Know

Cyber Week Sale! Join or renew for just $9 per year - $45 billed at the time of a purchase with a 5-year membership.
Join or renew
and get a FREE gift!

AARP Membership Cyber Week Sale

More From AARP