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Medigap enrollment and consumer protections vary across states

Series Title(s):
Issue brief (Henry J. Kaiser Family Foundation)
Author(s):
Boccuti, Cristina, author
Jacobson, Gretchen, author
Orgera, Kendal, author
Neuman, Tricia, author
Contributor(s):
Henry J. Kaiser Family Foundation, issuing body.
Publication:
San Francisco, CA : Henry J. Kaiser Family Foundation, July 2018
Language(s):
English
Format:
Text
Subject(s):
Consumer Advocacy
Insurance, Medigap -- legislation & jurisprudence
Medicare -- legislation & jurisprudence
Aged
Eligibility Determination -- legislation & jurisprudence
Federal Government
Health Services Accessibility
Insurance Benefits -- legislation & jurisprudence
State Government
Humans
United States
Genre(s):
Technical Report
Abstract:
One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015--also known as Medigap--to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries' access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period. Key Findings. (1) The share of beneficiaries with Medigap varies widely by state--from 3 percent in Hawaii to 51 percent in Kansas. (2) Federal law provides limited consumer protections for adults ages 65 and older who want to purchase a supplemental Medigap policy--including, a one-time, 6-month open enrollment period that begins when they first enroll in Medicare Part B. (3) States have the flexibility to institute consumer protections for Medigap that go beyond the minimum federal standards. For example, 28 states require Medigap insurers to issue policies to eligible Medicare beneficiaries whose employer has changed their retiree health coverage benefits. (4) Only four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in traditional Medicare ages 65 and older, regardless of medical history (Figure 1). Guaranteed issue protections prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions, such as diabetes and heart disease. (5) In all other states and D.C., people who switch from a Medicare Advantage plan to traditional Medicare may be denied a Medigap policy due to a pre-existing condition, with few exceptions, such as if they move to a new area or are in a Medicare Advantage trial period.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
Extent:
1 online resource (1 PDF file (16 pages))
Illustrations:
Illustrations
NLM Unique ID:
101740313 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/101740313
Series Title(s):
Issue brief (Henry J. Kaiser Family Foundation)
Author(s):
Boccuti, Cristina, author
Jacobson, Gretchen, author
Orgera, Kendal, author
Neuman, Tricia, author
Contributor(s):
Henry J. Kaiser Family Foundation, issuing body.
Publication:
San Francisco, CA : Henry J. Kaiser Family Foundation, July 2018
Language(s):
English
Format:
Text
Subject(s):
Consumer Advocacy
Insurance, Medigap -- legislation & jurisprudence
Medicare -- legislation & jurisprudence
Aged
Eligibility Determination -- legislation & jurisprudence
Federal Government
Health Services Accessibility
Insurance Benefits -- legislation & jurisprudence
State Government
Humans
United States
Genre(s):
Technical Report
Abstract:
One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015--also known as Medigap--to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries' access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period. Key Findings. (1) The share of beneficiaries with Medigap varies widely by state--from 3 percent in Hawaii to 51 percent in Kansas. (2) Federal law provides limited consumer protections for adults ages 65 and older who want to purchase a supplemental Medigap policy--including, a one-time, 6-month open enrollment period that begins when they first enroll in Medicare Part B. (3) States have the flexibility to institute consumer protections for Medigap that go beyond the minimum federal standards. For example, 28 states require Medigap insurers to issue policies to eligible Medicare beneficiaries whose employer has changed their retiree health coverage benefits. (4) Only four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in traditional Medicare ages 65 and older, regardless of medical history (Figure 1). Guaranteed issue protections prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions, such as diabetes and heart disease. (5) In all other states and D.C., people who switch from a Medicare Advantage plan to traditional Medicare may be denied a Medigap policy due to a pre-existing condition, with few exceptions, such as if they move to a new area or are in a Medicare Advantage trial period.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
Extent:
1 online resource (1 PDF file (16 pages))
Illustrations:
Illustrations
NLM Unique ID:
101740313 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/101740313

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