The Medicare Access and CHIP Reauthorization Act of 2015,
MACRA, requires the following standards are applicable to all Medicare
supplement polices or certificates delivered or issued for delivery in this
state to individuals newly eligible for Medicare with an effective date of
coverage 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 polices must comply with the following benefit standards. Benefit
plan standards applicable to Medicare supplement polices and certificates
issued to individuals eligible for Medicare before January 1, 2020, remain
subject to the requirements of Section 9 for policies issued after July 30,
1992 and prior to June 1, 2010; or 9a for policies issued after May 31, 2010
and prior to January 1, 2020.
A.
Benefit Requirements. The standards and requirements of Section 9b 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:
(1)
Standardized Medicare supplement benefit Plan C is redesignated as Plan D and
shall provide the benefits contained in Section 9a.E.(3) of this rule but shall
not provide coverage for 100% or any portion of the Medicare Part B deductible.
(2) Standardized Medicare
supplement benefit Plan F is redesignated as Plan G and shall provide the
benefits contained in Section 9a.E.(5)of this rule but shall not provide
coverage for 100% or any portion of the Medicare Part B deductible.
(3) 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.
(4) Standardized Medicare supplement benefit
Plan F With High Deductible is redesignated as Plan G With High Deductible and
shall provide the benefits contained in Section 9a.E(6) of this regulation but
shall not provide coverage for 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.
(5) The reference
to Plans C or F contained in Section 9a.A. (2) is deemed a reference to Plans D
or G for purposes of this section.
B. Applicability to Certain Individuals. This
Section 9b, applies to only individuals that are newly eligible for Medicare on
or after January 1, 2020:
(1) By reason of
attaining age 65 on or after January 1, 2020; or
(2) 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.
C. Guaranteed Issue for Eligible Persons. For
purposes of Section 12.E, 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 this Section
9b.A.
D. Offer of Redesignated
Plans to Individuals Other Than Newly Eligible. On or after January 1, 2020,
the standardized benefit plans described in Subparagraph A(4), 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 Section 9a.E of this
rule.
