A look at six state actions reshaping Medicare Supplement guaranteed issue rights, producer compensation, and fixed indemnity screening benefits this quarter.
Medicare Supplement
Delaware
Bulletin 164 (Revised) - Effective Date: September 25, 2026
The Department reissued its bulletin on carrier obligations under SB71, which took effect January 1, 2025 and introduced a birthday rule and guaranteed issue rights for individuals moving from Medicare Advantage to Original Medicare (18 Del. C. § 3411). The revised bulletin clarifies that guaranteed issue rights attach to the individual rather than the policy, and that Delaware residents are entitled to the Special Enrollment Period (SEP) regardless of where their Medigap policy was originally issued. Issuers authorized in the state must accept coverage during the SEP, file their required notice forms with the Department through an informational SERFF submission, and retain proof of notice distribution for audit and compliance review.
Idaho
Bulletin 26-14 - Effective Date: July 29, 2026
Medicare Supplement carriers must accept premium payments made by third parties on a policyholder's behalf, as long as those payments do not violate the anti-kickback provisions of the Social Security Act.
Minnesota
Bulletin 2026-3 - Effective Date: August 31, 2026
Following up on HF4, which we covered last quarter, the Department issued additional guidance on amended Minn. Stat. § 62A.31, effective August 1, 2026. Medigap carriers must offer guaranteed issue to first-time Medigap applicants aged 65 to 70 who apply during the new annual open enrollment periods: October 15 to December 7 and January 1 to March 31, or year-round for eligible institutionalized individuals. Policies issued under this provision carry a lifetime premium surcharge that starts at 15% for 2026 enrollees and rises to 35% for those enrolling in 2030 or later.
Oklahoma
Bulletin 2026-03 - Effective Date: August 5, 2026
In response to reduced or eliminated commissions on Medicare Supplement and Medicare Advantage products, the Oklahoma Insurance Department will allow licensed producers to charge beneficiaries a reasonable consulting fee for advisory services. A producer must choose one role per transaction: either an independent consultant paid by the beneficiary, or a commissioned agent acting on behalf of an MA plan, but not both. The fee must be reasonable and agreed upon in advance, and producers in either role must follow all applicable MA marketing and enrollment rules.
Rhode Island
Bulletin 2026-02 - Effective Date: September 4, 2026
Building on the guaranteed issue expansion in S3282 / H8595, the Office of the Health Insurance Commissioner issued guidance on the annual Medicare Supplement enrollment period, which aligns with the federal Medicare Annual Enrollment Period. Individuals with continuous qualifying coverage may switch to any available Medigap policy with guaranteed issue rights, provided no gap in coverage exceeds 90 days. Carriers must eliminate medical underwriting for eligible applicants and request only the documentation reasonably needed to verify eligibility.
Fixed Indemnity
Washington
SERFF Notice - Effective Date: August 27, 2026
The Office of the Insurance Commissioner updated its review process for screening benefits in specified disease and hospital indemnity filings to align with the federal CMS and tri-agency "sufficiently fixed" standard for excepted benefits. The change applies immediately to all new and pending filings and to market conduct reviews.
Under Washington statute, these products must pay a fixed dollar amount regardless of actual medical costs and must be triggered by a genuinely uncertain loss rather than a routine voluntary screening. Benefits must remain incidental to valid indemnity coverage, relate to a covered sickness or injury rather than act as standalone wellness benefits, and pay as independent cash benefits that do not coordinate with other coverage.
At the federal level, CMS requires these benefits to be issued under a separate policy, pay without regard to other coverage, and pay a predetermined flat cash amount. Benefits may not vary by CPT/HCPCS code, diagnosis, procedure, provider, site of service, fee schedule, or other clinical or cost factors.
The notice also sets product-specific expectations:
Specified disease screening benefits must be clinically tied to the named disease.
Group hospital indemnity screening benefits must connect to hospitalization under the federal fixed-benefit standard.
Individual hospital indemnity may include non-illness screenings only if they meet both the federal "sufficiently fixed" test and Washington's insurance-risk requirements.
A defined list of CMS-approved preventive screenings is permitted, including cancer screenings, lipid panels, diabetes, blood pressure, HIV/hepatitis, STI, depression/alcohol, DEXA, glaucoma, and abdominal ultrasound. The only allowable variation in the benefit amount is one based on uniformly applied time away from work, not fee schedules or CPT-based distinctions.
