Bill Sponsors
McGaw, Fogarty, Donovan, Potter, Cotter, Speakman, Kislak, Carson, DeSimone, and Kazarian
Committee
House Health & Human Services
Summary
Select
This bill amends the rules for Medicare Supplement Insurance (Medigap) policies in Rhode Island. Specifically, it changes the continuous coverage requirement for individuals seeking to switch Medigap or Medicare Advantage plans without medical underwriting during the annual enrollment period. Instead of measuring continuous coverage from the "Medicare Initial Enrollment Period," it now measures from the "Medigap Open Enrollment Period." This adjustment helps ensure that individuals with prior coverage can switch to any available Medigap policy without being denied or charged more based on their health status.
Sponsor
Analysis
Pros for Progressives
- Protects vulnerable seniors and disabled individuals from discriminatory medical underwriting when switching Medicare supplement plans, ensuring fair treatment regardless of health status.
- Expands healthcare accessibility by clarifying the continuous coverage timeline, preventing people from being trapped in inadequate or overly expensive Medicare Advantage plans.
- Strengthens the social safety net by ensuring that pre-existing conditions do not bar individuals from accessing necessary, comprehensive supplementary health insurance.
Cons for Progressives
- Maintains reliance on the private insurance market for essential healthcare coverage rather than moving toward a universal, single-payer system or expanding traditional Medicare.
- Retains a strict continuous coverage requirement (no gaps greater than 90 days), which may penalize low-income individuals who temporarily lose coverage due to financial hardship.
- Fails to address the underlying high premium costs of Medicare supplement policies, meaning these essential plans may remain unaffordable for many disadvantaged seniors.
Pros for Conservatives
- Encourages competition within the private health insurance market by making it easier for consumers to shop around and switch their Medigap policies annually.
- Promotes personal responsibility by requiring individuals to maintain continuous coverage (no gaps over ninety days) to qualify for guaranteed issue rights.
- Focuses on technical adjustments to existing insurance frameworks rather than creating costly new government-funded healthcare entitlement programs.
Cons for Conservatives
- Imposes strict government mandates on private insurance companies by forcing them to accept applicants without considering their health status or medical history.
- Prohibits individual medical underwriting, restricting the freedom of insurers to accurately price risk, which could lead to higher premiums for healthier enrollees.
- Represents continued government interference in the private healthcare market by dictating the terms of coverage rather than allowing free-market principles to govern policy issuance.
Constitutional Concerns
None Likely. This bill governs the insurance industry and its enrollment practices, which is well within the state's established regulatory authority and police powers. It does not implicate free speech, due process, or unreasonable searches and seizures.
Impact Overview
Groups Affected
- Medicare beneficiaries
- Seniors (age 65 and older)
- Individuals with disabilities
- Health insurance companies
- Individuals with end-stage renal disease
Towns Affected
All
Cost to Taxpayers
None
Revenue Generated
None
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Bill Status
Current Status
Held
Comm Passed
Floor Passed
Law
History
• 05/27/2026 Introduced, referred to House Health & Human Services
• 05/29/2026 Scheduled for hearing and/or consideration (06/02/2026)
• 06/02/2026 Committee recommended measure be held for further study
• 05/29/2026 Scheduled for hearing and/or consideration (06/02/2026)
• 06/02/2026 Committee recommended measure be held for further study
Bill Text
SECTION 1. Section 27-18.2-3 of the General Laws in Chapter 27-18.2 entitled "Medicare Supplement Insurance Policies" is hereby amended to read as follows:
27-18.2-3. Standards for policy provisions.
(a) No Medicare supplement insurance policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare.
(b) Notwithstanding any other provision of law of this state, a Medicare supplement policy or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.
(c) The commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates. Those standards shall be in addition to and in accordance with the applicable laws of this state, including but not limited to §§ 27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the minimum standards contained in this chapter, shall apply to Medicare supplement policies and certificates. The standards may cover, but not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions, and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
(d) The commissioner may adopt reasonable regulations that specify prohibited policy provisions not specifically authorized by statute, if, in the opinion of the commissioner, those provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate.
(e) The commissioner shall adopt reasonable regulations to establish minimum standards for premium rates, benefits, claims payment, marketing practices, and compensation arrangements and reporting practices for Medicare supplement policies and certificates.
(f) The commissioner may adopt any reasonable regulations necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated pursuant to federal law, including but not limited to:
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reporting loss ratios;
(3) Assuring public access to policies, premiums, and loss ratio information of issuers of Medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approval of premium increases that may include the applicant’s provision of notice of the proposed premium increase to all subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and
(6) Establishing standards for Medicare select policies and certificates.
(g) Each Medicare supplement Plan A policy or applicable certificate that an issuer currently, or at any time hereafter, makes available in this state shall be made available to any applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability or end- stage renal disease, provided that the applicant submits their application during the first six (6) months immediately following the applicant’s initial eligibility for Medicare Part B, or alternate LC006489 - Page 2 of 4 enrollment period as determined by the commissioner. The issuance or coverage of any Medicare supplement policy pursuant to this section shall not be conditioned on the medical or health status or receipt of health care by the applicant; and no insurer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this subsection.
(1) Any individual under the age of sixty-five (65) enrolled in a Medicare supplement Plan A by reason of disability or end-stage renal disease pursuant to subsection (g) of this section, shall receive a six-month (6) open enrollment period for any policy or applicable certificate that an issuer currently makes available in this state beginning on the first day of the month in which the individual both attains the age of sixty-five (65) and remains enrolled in Medicare Parts A & B.
(h) Each year, for the duration of the Medicare Annual Enrollment Period (AEP) for coverage with an effective date of January 1 of the following year, an individual enrolled in a Medicare supplement policy or Medicare Advantage plan who has been covered by any Medicare supplement policy(s) or Medicare Advantage plan(s) or another form of credible coverage with no gap in coverage greater than ninety (90) days beginning from that individual’sMedicare Initial Enrollment Period (IEP) Medigap Open Enrollment Period, shall be afforded guaranteed issue rights for any available Medicare supplement policy or applicable certificate that an issuer currently makes available in this state.
(1) The issuance or coverage of any Medicare supplement policy pursuant to subsection (h) of this section shall not be conditioned on the medical or health status or receipt of health care by the applicant and no issuer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this subsection.
(2) For those individuals under the age of sixty-five (65) enrolled in a Medicare Advantage or Medicare supplement Plan A due to a disability, pursuant to subsection (g) of this section the individual shall be afforded guaranteed issue rights for every Medicare supplement Plan A policy or applicable certificate that an issuer makes available in this state. Coverage shall be afforded pursuant to subsection (h)(1) of this section.
SECTION 2. This act shall take effect upon passage.
27-18.2-3. Standards for policy provisions.
(a) No Medicare supplement insurance policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare.
(b) Notwithstanding any other provision of law of this state, a Medicare supplement policy or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.
(c) The commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates. Those standards shall be in addition to and in accordance with the applicable laws of this state, including but not limited to §§ 27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the minimum standards contained in this chapter, shall apply to Medicare supplement policies and certificates. The standards may cover, but not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions, and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
(d) The commissioner may adopt reasonable regulations that specify prohibited policy provisions not specifically authorized by statute, if, in the opinion of the commissioner, those provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate.
(e) The commissioner shall adopt reasonable regulations to establish minimum standards for premium rates, benefits, claims payment, marketing practices, and compensation arrangements and reporting practices for Medicare supplement policies and certificates.
(f) The commissioner may adopt any reasonable regulations necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated pursuant to federal law, including but not limited to:
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reporting loss ratios;
(3) Assuring public access to policies, premiums, and loss ratio information of issuers of Medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approval of premium increases that may include the applicant’s provision of notice of the proposed premium increase to all subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and
(6) Establishing standards for Medicare select policies and certificates.
(g) Each Medicare supplement Plan A policy or applicable certificate that an issuer currently, or at any time hereafter, makes available in this state shall be made available to any applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability or end- stage renal disease, provided that the applicant submits their application during the first six (6) months immediately following the applicant’s initial eligibility for Medicare Part B, or alternate LC006489 - Page 2 of 4 enrollment period as determined by the commissioner. The issuance or coverage of any Medicare supplement policy pursuant to this section shall not be conditioned on the medical or health status or receipt of health care by the applicant; and no insurer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this subsection.
(1) Any individual under the age of sixty-five (65) enrolled in a Medicare supplement Plan A by reason of disability or end-stage renal disease pursuant to subsection (g) of this section, shall receive a six-month (6) open enrollment period for any policy or applicable certificate that an issuer currently makes available in this state beginning on the first day of the month in which the individual both attains the age of sixty-five (65) and remains enrolled in Medicare Parts A & B.
(h) Each year, for the duration of the Medicare Annual Enrollment Period (AEP) for coverage with an effective date of January 1 of the following year, an individual enrolled in a Medicare supplement policy or Medicare Advantage plan who has been covered by any Medicare supplement policy(s) or Medicare Advantage plan(s) or another form of credible coverage with no gap in coverage greater than ninety (90) days beginning from that individual’s
(1) The issuance or coverage of any Medicare supplement policy pursuant to subsection (h) of this section shall not be conditioned on the medical or health status or receipt of health care by the applicant and no issuer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this subsection.
(2) For those individuals under the age of sixty-five (65) enrolled in a Medicare Advantage or Medicare supplement Plan A due to a disability, pursuant to subsection (g) of this section the individual shall be afforded guaranteed issue rights for every Medicare supplement Plan A policy or applicable certificate that an issuer makes available in this state. Coverage shall be afforded pursuant to subsection (h)(1) of this section.
SECTION 2. This act shall take effect upon passage.