Medigap Enrollment and Consumer Protections Vary Across States
Issue Brief
J. Huang, G. Jacobson, T. Neuman, K. Desmond, and T. Rice “Medigap: Spotlight on Enrollment, Premiums, and Recent Trend” The Kaiser Family Foundation, April 2013. https://www.kff.org/wp-content/uploads/2013/04/8412-2.pdf
“The Omnibus Budget Reconciliation Act of 1990 (OBRA-90),” HR 5835, Public Law No: 101-508, November 1990. Available at: https://www.congress.gov/bill/101st-congress/house-bill/5835.
The share of beneficiaries with Plan C and F is expected to decline in the future due to a change in law that prohibits insurers from issuing new policies that cover the full Part B deductible, as Plans C and F currently cover. Existing C and F policies will be grandfathered and therefore, renewable by current policyholders, but not sold to new purchasers. “Medicare Access and CHIP reauthorization Act of 2015 (MACRA),” HR 2, Public Law No: 114-10, April 2015. Available at: https://www.congress.gov/bill/114th-congress/house-bill/2/text.
Jacobson, G, Damico A, Neuman T, and Gold M. “Medicare Advantage 2017 Spotlight: Enrollment Market Update,” Kaiser Family Foundation, June 2017. Available at: https://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/
Pre-existing conditions apply to conditions for which medical advice was given or treatment received within a “look back period” of six months before the effective date of coverage. For further details on federal requirements for Medigap with respect to pre-existing conditions, see https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf.
“The Omnibus Budget Reconciliation Act of 1990 (OBRA-90),” HR 5835, Public Law No: 101-508, November 1990. Available here: https://www.congress.gov/bill/101st-congress/house-bill/5835.
Neuman, Tricia, “Traditional Medicare…Disadvantaged?” Kaiser Family Foundation, March 2016. Available at: https://www.kff.org/medicare/perspective/traditional-medicare-disadvantaged/; Jacobson G, Rae M, Neuman T, Orgera K, Boccuti C. “Medicare Advantage: How Robust Are Plans’ Physician Networks?,” Kaiser Family Foundation, October 2017. Available at: http://files.kff.org/attachment/Report-Medicare-Advantage-How-Robust-Are-Plans-Physician-Networks.
Pre-existing conditions apply to conditions for which medical advice was given or treatment received within a “look back period” of six months before the effective date of coverage. Continuous coverage means that the applicant had no break in coverage greater than 63 days over the prior six-month period prior to purchasing the Medigap policy. In New York, Medigap insurers must reduce the waiting period by the number of days that applicants had continuous creditable coverage.
Under federa law, Medicare beneficiaries may suspend Medigap for up to two years if they become eligible for Medicaid, in which case they have no new medical underwriting or waiting periods for pre-existing conditions when they restart their Medigap.
Centers for Medicare & Medicaid Services and the National Association of Insurance Commissioners, “2017 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare,” 2017. Available at: https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf.
J. Huang, G. Jacobson, T. Neuman, K. Desmond, and T. Rice “Medigap: Spotlight on Enrollment, Premiums, and Recent Trend” The Kaiser Family Foundation, April 2013. https://www.kff.org/wp-content/uploads/2013/04/8412-2.pdf
Some states may allow Medigap insurers to charge higher premiums if they offer added coverage options, such as dental or vision coverage.
Neuman, Tricia, “Traditional Medicare…Disadvantaged?” Kaiser Family Foundation, March 2016. Available at: https://www.kff.org/medicare/perspective/traditional-medicare-disadvantaged/
Proposals to add an out-of-pocket limit have been discussed by the Medicare Payment Advisory Commission. See, for example, its chapter, “Reforming Medicare’s benefit design,” Report to the Congress: Medicare and the Health Care Delivery System (June 2012). http://medpac.gov/docs/default-source/reports/jun12_ch01.pdf?sfvrsn=0