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Date: April 5, 1995
FOR IMMEDIATE RELEASE 
Contact:  Anne Verano, HCFA (202) 690-6145

Changes in Medigap Open Enrollment Law
Creates Special Enrollment Period for
Certain Medicare Beneficiaries

Bruce C. Vladeck, administrator of the Health Care Financing Administration, has announced changes in the open enrollment rules that govern the selling of Medicare supplemental health insurance (commonly referred to as Medigap) to certain Medicare beneficiaries who were enrolled in Medicare Part B prior to turning age 65.

"These changes in the Medigap law ensure that Medicare beneficiaries who were enrolled in Medicare Part B prior to turning 65 are eligible for the same Medigap open enrollment options, once they reach age 65, as all other Medicare beneficiaries," Vladeck said.

All Medicare beneficiaries are now given a one-time six-month open enrollment period for Medigap insurance when they are both 65 or older and are enrolled in Medicare Part B.

During open enrollment, a beneficiary must be offered any Medigap policy an insurer sells and the policy must be offered at the insurer's most favorable price. This means that the beneficiary cannot be refused a policy or charged a higher price because of a pre-existing condition or past claims experience.

However, even during open enrollment, insurers may apply a waiting period of up to six months for benefits related to the treatment of a pre-existing condition. In this case, a pre-existing condition is defined as a condition that is diagnosed or treated during the six months prior to the purchase of a Medigap policy. These rules apply to all Medigap policies, including policies that cover outpatient prescription drugs which most insurers medically underwrite outside of open enrollment periods.

A special one-time six-month Medigap open enrollment period is now in effect for all Medicare beneficiaries who turned 65 between Nov. 5, 1991, and Jan. 1, 1995, and were either temporarily or continuously enrolled in Medicare Part B prior to reaching age 65 because of a disability or end stage renal disease. This special period ends on June 30, 1995.

To obtain further information about the Medigap open enrollment rules, beneficiaries can contact the Medicare hotline at 1-800-638-6833. The TTY number for the hearing and speech impaired is 1-800-820-1202.

These changes to the Medigap law were included in the Social Security Act Amendments of 1994 (SSAA-94).

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