The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) requires the following standards are applicable to all Medicare
supplement policies or certificates 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, 2020All 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 Section
8 of this regulation.
(a) Benefit Requirements. The standards and
requirements of Section 9.1 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:
(i) Standardized Medicare supplement benefit
Plan C is redesignated as Plan D and shall provide the benefits contained in
Section 9.1(e)(iii) of this regulation but shall not provide coverage for one
hundred percent (100%) or any portion of the Medicare Part B
deductible.
(ii) Standardized
Medicare supplement benefit Plan F is redesignated as Plan G and shall provide
the benefits contained in Section 9.1(e)(v) of this regulation but shall not
provide coverage for one hundred percent (100%) or any portion of the Medicare
Part B deductible.
(iii)
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.
(iv) 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
9.1(e)(vi) of this regulation 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.
(v) The reference to
Plans C or F contained in Section 9.1(a)(ii) is deemed a reference to Plans D
or G for purposes of this section.
(b) Applicability to Certain Individuals.
This Section 9.2, applies to only individuals that are newly eligible for
Medicare on or after January 1, 2020:
(i) by
reason of attaining age 65 on or after January 1, 2020; or
(ii) 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 9.2(a).
(d) Applicability to Waivered States. In the
case of a State described in Section 1882(p)(6) of the Social Security Act
("waivered" alternative simplification states) MACRA prohibits the coverage of
the Medicare Part B deductible for any Medicare supplement policy sold or
issued to an individual that is newly eligible for Medicare on or after January
1, 2020.
(e) Offer of Redesignated
Plans to Individuals Other Than Newly Eligible. On or after January 1, 2020,
the standardized benefit plans described in subparagraph (a)(iv), 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 9.1(e) of this
regulation.
