The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) requires the following standards to be applicable to all Medicare
supplement policies delivered or issued for delivery in this state to
individuals newly eligible for Medicare on or after January 1, 2020. No policy
or certificate that provides coverage of the Medicare Part B deductible may be
advertised, solicited, delivered or issued for delivery in this state as a
Medicare supplement policy or certificate to individuals newly eligible for
Medicare on or after January 1, 2020. All policies must comply with the
following benefit standards. Benefit plan standards applicable to Medicare
supplement policies and certificates issued to individuals eligible for
Medicare before January 1, 2020 remain subject to the requirements of OAR
836-052-0103 to
836-052-0194.
(1) Benefit Requirements. The standards and
requirements of OAR
836-052-0141 shall apply to all
Medicare supplement policies or certificates delivered or issued for delivery
to individuals newly eligible for Medicare on or after January 1, 2020 with the
following exceptions:
(a) Standardized
Medicare supplement benefit Plan C is redesignated as Plan D and shall provide
the benefits contained in OAR
836-052-0141(5)(c)
but shall not provide coverage for one hundred percent (100%) or any portion of
the Medicare Part B deductible.
(b)
Standardized Medicare supplement benefit Plan F is redesignated as Plan G and
shall provide the benefits contained in OAR
836-052-0141(5)(e)
but shall not provide coverage for one hundred percent (100%) or any portion of
the Medicare Part B deductible.
(c)
Standardized Medicare supplement benefit plans C, F and F With High Deductible
may not be offered to individuals newly eligible for Medicare on or after
January 1, 2020.
(d) Standardized
Medicare supplement benefit Plan F With High Deductible is redesignated as Plan
G With High Deductible and shall provide the benefits contained in OAR
836-052-0141(5)(f)
but shall not provide coverage for one hundred percent (100%) or any portion of
the Medicare Part B deductible; provided further that the Medicare Part B
deductible paid by the beneficiary shall be considered an out-of-pocket expense
in meeting the annual high deductible.
(e) The reference to Plans C or F contained
in OAR
836-052-0141(1)(b)
is deemed a reference to Plans D or G for purposes of this
section.
(2)
Applicability to Certain Individuals. This section, OAR
836-052-0144, applies to only
individuals that are newly eligible for Medicare on or after January 1, 2020:
(a) By reason of attaining age 65 on or after
January 1, 2020; or
(b) By reason
of entitlement to benefits under Part A pursuant to section 226(b) or 226A of
the Social Security Act, or who is deemed to be eligible for benefits under
section 226(a) of the Social Security Act on or after January 1,
2020.
(3) Guaranteed
Issue for Eligible Persons. For purposes of OAR
836-052-0142, in the case of any
individual newly eligible for Medicare on or after January 1, 2020, any
reference to a Medicare supplement policy C or F (including F With High
Deductible) shall be deemed to be a reference to Medicare supplement policy D
or G (including G With High Deductible) respectively that meet the requirements
of OAR
836-052-0144.
(4) Offer of Redesignated Plans to
Individuals Other Than Newly Eligible. On or after January 1, 2020, the
standardized benefit plans described in OAR
836-052-0144(1)(d)
above may be offered to any individual who was eligible for Medicare prior to
January 1, 2020 in addition to the standardized plans described in OAR
836-052-0141(5).
