Establish narrow, clearly bounded guaranteed-issue rights for Medicare Supplement policies in West Virginia.
HB4869 creates a new article in West Virginia insurance law establishing limited guaranteed-issue rights for Medicare supplement policies, also known as Medigap policies. The bill gives eligible policyholders a once-per-year “birthday” enrollment window to replace an existing Medicare supplement policy with the same or lesser standardized benefits, provided the current policy has been continuously in force for at least 24 months. During that window, insurers may not deny coverage, impose medical underwriting, or apply pre-existing condition exclusions or waiting periods. If an insurer and its affiliates have not accepted applications for a comparable policy for at least 12 months, the applicant may seek the same-or-lesser coverage from any authorized insurer in the state.
The bill also creates a separate guaranteed-issue right for certain older individuals who lose Medicaid eligibility. A person age 65 or older who is entitled to Medicare and loses Medicaid coverage, including full or partial dual eligibility, may buy any Medicare supplement policy actively offered for new enrollees within 63 days after Medicaid ends, without underwriting or waiting periods. The bill expressly excludes Medicare Advantage plans and does not create a broader open enrollment period or require insurers to offer new products or higher benefits than they already sell.
HB4869 also requires the Insurance Commissioner to submit an annual report to the Legislature on Medicare supplement premium trends, including insurer-by-insurer changes, statewide averages, and plan-type trends. The commissioner is authorized to adopt rules only to administer the new section, such as verifying eligibility and coordinating effective dates, but not to expand eligibility or regulate rates. The law applies to policies issued, reissued, extended, or materially changed on or after June 1, 2026, and takes effect 90 days from passage.
The bill’s impact is to add consumer protections and portability options for Medigap enrollees while preserving insurer limits on what products must be offered and what rating rules remain lawful. It affects insurers authorized to sell Medicare supplement policies in West Virginia, current Medigap policyholders, and certain seniors losing Medicaid coverage. It also adds a new reporting obligation for the Insurance Commissioner, but explicitly stops short of authorizing premium regulation or rate setting.
The overall sentiment appears strongly favorable and largely noncontroversial. The bill passed the House 87-1 and the Senate unanimously 32-0, suggesting broad bipartisan support for the narrowly tailored consumer protections. The main policy balance reflected in the text is between expanding guaranteed access for consumers and preserving insurer discretion over product offerings, pricing classifications, and the scope of coverage available in the market.
HB4869 amends the West Virginia Insurance Code by adding new §33-15F-1, creating statutory guaranteed-issue rights for Medicare supplement policies under specified circumstances. It changes the rights of Medigap policyholders and certain Medicaid-disenrolled seniors by limiting insurer underwriting and denial authority during defined application windows, while leaving intact existing lawful rating classifications and excluding Medicare Advantage plans. The bill also imposes an annual premium-trend reporting duty on the Insurance Commissioner and authorizes limited rulemaking to administer eligibility and timing requirements.
The bill appears to have enjoyed broad support with very little opposition. It passed the House by 87-1 and the Senate by 32-0, indicating a strong consensus in favor of the measure. The discussion context provided does not show committee controversy, and the bill’s structure suggests a compromise approach that expands consumer access while explicitly limiting its reach.
The main points of contention, to the extent they exist in the text, concern how far guaranteed-issue rights should extend and how much they should affect insurers. The bill narrowly limits access to same-or-lesser standardized benefits, requires continuous coverage for the birthday option, and preserves existing rating rules, which suggests an effort to avoid broader market disruption. Potentially affected stakeholders include Medicare supplement insurers, policyholders seeking to switch plans, and seniors losing Medicaid eligibility; however, the vote totals indicate these issues did not generate significant recorded opposition.