Delaware May Expand When Seniors Can Switch Medigap Plans

Delaware lawmakers are advancing legislation that could significantly change how Medicare beneficiaries in the First State shop for and switch Medicare Supplement insurance, commonly known as Medigap. The proposal under consideration in Dover would create a new annual enrollment window during which seniors could apply for or change Medigap plans without being subject to medical underwriting — meaning insurers could not deny coverage or charge higher premiums based on a person's health conditions or medical history. For the roughly 200,000 Medicare beneficiaries in Delaware, this kind of protection could mean real dollars saved and real access gained, particularly for those managing chronic conditions who currently face the steepest barriers when trying to switch plans.

To understand why this matters, it helps to know how Medigap enrollment works under current federal rules. When you first become eligible for Medicare Part B — typically at age 65 — you have a six-month federal Open Enrollment Period during which insurers must sell you any Medigap plan they offer at standard rates, regardless of your health. Once that window closes, federal law gives insurers in most states the right to use medical underwriting. That means a 72-year-old with diabetes, heart disease, or a history of cancer can be turned down entirely or quoted a premium far higher than a healthier peer. For many seniors, this effectively locks them into whatever plan they chose at 65, even if their needs have changed or better-priced options have entered the market.

Delaware currently follows the federal baseline, which offers no guaranteed annual switching right outside of specific qualifying events — like losing employer coverage or moving out of a plan's service area. The proposed legislation would change that by establishing a state-level guaranteed issue right on an annual basis, giving beneficiaries a defined window each year — likely tied to their birthday or a fixed calendar period — to comparison shop and switch without fear of being medically screened out. The Delaware Department of Insurance, led by Commissioner Trinidad Navarro and reachable at insurance.delaware.gov, would oversee implementation and enforcement of any new rules.

Thirteen states have already moved beyond federal minimums in this area, and their experiences offer a preview of what Delaware beneficiaries might expect. California pioneered the birthday rule, which gives residents a 30-day window around their birthday each year to switch to a Medigap plan with equal or lesser benefits without underwriting. States including Oregon, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, and Oklahoma have adopted similar or stronger protections. In New York and Connecticut, guaranteed issue rights apply year-round, meaning insurers can never use medical underwriting for Medigap — a model that maximizes consumer flexibility but can also affect how insurers price plans in those markets. Delaware's proposal appears to fall somewhere in between: more protection than the federal floor, but likely structured as a defined annual window rather than a continuous right.

For Delaware seniors trying to figure out what this could mean in practical terms, consider the Medigap landscape in 2025. Standardized Medigap plans are labeled A through N, and the most popular options — Plan G and Plan N — carry meaningfully different premiums depending on the insurer, even for identical benefits. Plan G, which covers nearly all Medicare cost-sharing except the Part B deductible (set at $257 in 2025), can range from roughly $120 to over $200 per month for a 70-year-old in many markets, depending on the carrier. Plan N, which requires small copays for some office and emergency room visits, typically runs $30 to $50 less per month than Plan G. A senior locked into a higher-priced Plan G from a carrier that has raised rates aggressively could be paying $600 to $900 more per year than necessary — but without guaranteed issue rights, switching to a lower-cost carrier means risking denial if they have any significant health history.

The legislation also addresses a quiet but serious equity issue in Medicare supplemental coverage. Seniors who were healthy at 65 and enrolled in Medigap during their initial open enrollment period are largely protected — they can keep their plan indefinitely and insurers cannot drop them for developing health problems. But beneficiaries who delayed Medigap enrollment, chose Medicare Advantage at 65 and later want to switch back to Original Medicare, or simply didn't understand their options during that initial window are left in a much more precarious position. These groups skew toward lower-income seniors, those who were still working at 65 and covered by employer insurance, and people who enrolled in Medicare due to disability before age 65. Expanding guaranteed issue rights would give these beneficiaries a meaningful second chance to access comprehensive supplemental coverage.

It's worth noting what the proposed legislation would and would not do. A guaranteed issue window means insurers must accept your application and charge standard rates — it does not mean all plans become free or that premiums are regulated to a single price. Insurers in Delaware would still be able to use attained-age, issue-age, or community rating methods to set base premiums, and those premiums can still vary by carrier. What changes is the ability to comparison shop across carriers without your health history being used against you. Beneficiaries would still want to compare Plan G versus Plan N carefully, review each carrier's rate increase history (available through the Delaware Department of Insurance), and consider whether a high-deductible Plan G — which carries a $2,870 deductible in 2025 but much lower monthly premiums — might fit their financial situation.

For Delaware beneficiaries who want to act now, regardless of how the legislation progresses, there are existing options worth knowing. If you are within six months of your Part B effective date, you are in your federal Open Enrollment Period and have full guaranteed issue rights today — use them. If you have a qualifying Special Enrollment Period event, such as losing creditable coverage from an employer or union plan, you also have guaranteed issue rights for a limited time. Seniors who enrolled in a Medicare Advantage plan and want to return to Original Medicare with a Medigap policy should be aware that the federal trial right — which applies if you joined Medicare Advantage for the first time and want to switch back within 12 months — provides guaranteed issue access to certain Medigap plans. The Delaware Department of Insurance's SHIP (State Health Insurance Assistance Program) counselors offer free, unbiased help navigating these options and can be reached through the department's website at insurance.delaware.gov.

The broader policy trend here is significant. Consumer advocates and aging policy researchers have long argued that the federal Medigap framework creates a two-tier system: robust protections for the healthy and well-informed at 65, and a largely unprotected market for everyone else. As more states adopt birthday rules or annual guaranteed issue windows, pressure may build on Congress to establish a federal standard that applies nationwide. For now, Delaware beneficiaries are watching Dover closely — and if this legislation passes, the annual window it creates could become one of the most valuable consumer protections in the state's Medicare landscape.