Indiana Bill Would Expand Medigap Access for Medicare Beneficiaries

Indiana Medicare beneficiaries may soon have more choices when it comes to Medicare Supplement insurance, thanks to legislation advancing through the state's General Assembly. A bill sponsored by Representative Dant Chesser has moved through the Indiana House and is now under Senate consideration. The legislation aims to create new pathways for accessing Medicare Supplement insurance — commonly called Medigap — and reflects a growing national debate about whether beneficiaries have fair, realistic access to the supplemental coverage that protects them from Original Medicare's substantial cost-sharing gaps. For Indiana's roughly 1.3 million Medicare enrollees, the outcome of this bill could meaningfully change their coverage options for years to come.

To understand why this legislation matters, you first need to understand what Original Medicare actually leaves uncovered. Medicare Parts A and B pay for a broad range of hospital and medical services, but the gaps are significant. In 2025, the Medicare Part A hospital deductible is $1,676 per benefit period — and unlike most private insurance, there is no single annual deductible. If you are hospitalized more than once in a year across separate benefit periods, that deductible can apply multiple times. The Part B deductible is $257 per year, and after that, you owe 20% of the Medicare-approved cost for most outpatient services with no annual out-of-pocket cap. For someone managing cancer, heart disease, or a major orthopedic surgery, that uncapped 20% coinsurance can reach tens of thousands of dollars in a single year. Medigap plans are standardized by the federal government and sold by private insurers specifically to fill those gaps.

There are ten standardized Medigap plan types available in most states, labeled Plans A through N. The most comprehensive option available to new enrollees in 2025 is Plan G, which covers the Part A deductible, all coinsurance and copayments, skilled nursing facility coinsurance, and Part B excess charges — everything except the $257 Part B deductible. Plan N is a lower-premium alternative that covers the Part A deductible and coinsurance but requires copays of up to $20 for office visits and up to $50 for emergency room visits, and does not cover Part B excess charges. Monthly premiums vary considerably by age, gender, tobacco use, zip code, and the insurer's rating method. A 65-year-old woman in Indianapolis might pay roughly $110 to $160 per month for Plan G depending on the carrier, while a 72-year-old man in the same city could pay $180 to $250 or more. The financial logic of Medigap is straightforward: you trade a predictable monthly premium for near-elimination of surprise medical bills.

Premium rating method is one of the most important and least discussed factors in choosing a Medigap plan, and Indiana beneficiaries should understand it before signing up. Insurers use three approaches. Community-rated plans charge the same premium to everyone regardless of age — a 65-year-old and a 78-year-old pay the same amount. Issue-age-rated plans set your premium based on your age at enrollment and do not increase it as you get older, though they may adjust for inflation. Attained-age-rated plans start with lower premiums at 65 but increase as you age, often becoming the most expensive option by your mid-70s. Attained-age rating is common in Indiana, which means a Plan G that costs $130 per month at 65 could cost $210 or more by age 75 from the same insurer. When comparing plans, always ask the carrier which rating method they use — it can make a difference of thousands of dollars over a decade.

The central problem that Rep. Chesser's bill attempts to address is access after the initial enrollment window closes. Under federal rules, every beneficiary has a guaranteed issue right during their six-month Medigap Open Enrollment Period, which begins the month they turn 65 and are enrolled in Medicare Part B. During this window, insurers cannot deny coverage, charge higher premiums, or impose waiting periods based on health status. Once that window closes, however, most states — including Indiana — allow insurers to use medical underwriting. That means an insurer can review your health history and either reject your application outright or quote a premium so high it is effectively unaffordable. Indiana currently has no birthday rule or other state-level guaranteed issue protection beyond the federal baseline, leaving many beneficiaries with no realistic path to Medigap if they missed or skipped their initial window.

Thirteen states have enacted birthday rules or comparable guaranteed issue protections that give beneficiaries an annual window — typically 30 days around their birthday — to switch Medigap plans without medical underwriting. Those states are California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, and Oregon. Indiana is not among them. If Rep. Chesser's bill creates a birthday rule or a similar defined annual window, it would place Indiana alongside those states and give beneficiaries a recurring opportunity to shop for better rates or switch plan types without fear of being denied based on their health. That is a meaningful protection, particularly for people who developed chronic conditions after their initial enrollment window closed.

The Medicare Advantage-to-Medigap transition is where this issue becomes most acute for Indiana beneficiaries. Nationally, more than half of all Medicare enrollees are now in Medicare Advantage plans, which are private insurance alternatives to Original Medicare that typically offer $0 or low monthly premiums and added benefits like dental, vision, and hearing coverage. But Medicare Advantage plans come with trade-offs that become more apparent as people age and their health needs grow. Provider networks can be restrictive, prior authorization requirements can delay or deny care, and while out-of-pocket maximums are capped at $9,350 for in-network services in 2025, that cap still represents a significant financial exposure for someone with serious health needs. When beneficiaries in Medicare Advantage plans decide they want the broader provider access of Original Medicare paired with a Medigap policy, they often discover that their accumulated health history makes them uninsurable or unaffordable in the Medigap market.

Consider a realistic Indiana scenario: a 70-year-old in Fort Wayne who enrolled in a Medicare Advantage HMO at 65 when she was healthy, has since developed Type 2 diabetes, hypertension, and mild kidney disease, and now wants to switch to Original Medicare with a Plan G supplement because her specialist is no longer in her plan's network. Without a guaranteed issue protection, every Medigap insurer she approaches can legally decline her application based on those diagnoses. She is effectively locked into Medicare Advantage regardless of whether it continues to meet her needs. Legislation that creates a defined window — even once per year — where insurers must accept her application regardless of health status would give her a genuine choice that she currently does not have.

For Indiana beneficiaries watching this legislation, the most important immediate action is to protect the enrollment rights you already have. If you are approaching 65, your six-month Medigap Open Enrollment Period is the most valuable coverage window you will ever have — use it deliberately. Even if you are leaning toward Medicare Advantage for its lower premiums or extra benefits, carefully weigh whether a Medigap plan might serve you better over the long term before that guaranteed issue window closes permanently under current law. If you are already past 65 and enrolled in Medicare Advantage, speak with a licensed Indiana insurance broker now about your current options and what health conditions might affect your Medigap eligibility. Some federal Special Enrollment Periods — such as when a Medicare Advantage plan leaves your service area or loses its Medicare contract — do trigger guaranteed issue rights for Medigap, so understanding those triggers is worth your time.

The Indiana Department of Insurance regulates Medigap plans sold in the state and can confirm which guaranteed issue rights currently apply to your situation. Their website is www.in.gov/idoi, and their consumer helpline can answer questions about specific plan availability, insurer licensing, and any new rules that take effect if Rep. Chesser's bill becomes law. Indiana also participates in the federally funded State Health Insurance Assistance Program, known as SHIP, which provides free, unbiased Medicare counseling. Indiana's SHIP program, called SHIP Indiana, can be reached through the Indiana Family and Social Services Administration and offers one-on-one help comparing Medigap plans, understanding enrollment windows, and evaluating Medicare Advantage alternatives.

It is also critical to keep Medicare's various enrollment windows straight, because confusing them is one of the most common and costly mistakes beneficiaries make. The Annual Enrollment Period, running October 15 through December 7 each year, applies to Medicare Advantage and Part D prescription drug plans — not to Medigap. The Medicare Advantage Open Enrollment Period, running January 1 through March 31, also applies only to Medicare Advantage — not Medigap. Medigap has no annual open enrollment period under current federal rules. Your ability to switch Medigap plans depends entirely on your state's protections and any qualifying life events that trigger a federal Special Enrollment Period. If Indiana's legislation creates a new annual window for Medigap switching, that would represent a genuinely new enrollment opportunity — one that does not currently exist for most Indiana beneficiaries and one worth building your coverage calendar around.

The broader significance of this bill extends beyond Indiana. States have historically had the authority to expand Medicare Supplement protections beyond the federal floor, and the thirteen states with birthday rules demonstrate that such expansions are legally and administratively feasible. Indiana's legislature taking up this issue signals that state policymakers are hearing from constituents who feel the current system traps them in coverage that no longer fits their needs. Whether Rep. Chesser's bill passes in its current form, is amended in the Senate, or lays the groundwork for future legislation, the conversation it is generating is a reminder that Medigap enrollment decisions made at 65 carry consequences that can last decades — and that the rules governing those decisions are not fixed.