MACRA – changes to Medigap plans for everyone aging in after January 1, 2020

Minnesota, along with Massachusetts and Wisconsin are Medigap exemption states, meaning in addition to local plans we have rich local alternatives such as Senior Gold and Basic Blue. However, the Medicare and Children’s Health Insurance Program (MACRA) passed in 2015 affects ALL plans.

The key difference under MACRA is that as of January 1, 2020, the Part B deductible can no longer be covered.  This means that all national and local Medigap plans have to change.  Senior Gold and Basic Blue will start again for new enrollees, meaning lower premiums for new members.

Read on to learn what plans are ending, new plans and changes MACRA has on Medigap across Minnesota and the country.

And as always let our team know if you have any questions.

What to know

  • Anyone who qualified for Medicare before January 1st 2020, will still be able to sign up and change plans at any future date.
  • MACRA states that, as of January 1, 2020, Plan G and H (including the High Deductible plan) will no longer be able to accept new members.
  • Plans G and H will be replaced by Plans D or G respectively (with a HD option). These plans will be the same as G & H except for the Part B deductible.
  • If your clients are currently age 65 or will be age 65 before January 1, 2020, MACRA DOES NOT affect them.
  • If your clients first became eligible for Medicare due to age, disability or end-stage renal disease before January 1, 2020, MACRA DOES NOT affect them.
  • All other Medigap plans will remain unchanged
  • Medigap coverage is guaranteed renewable and, so long as the policyholder pays the premium, the coverage cannot be cancelled.

For more detailed information contact LeClair Group’s Brokerage team at Sales@LeClairGroup.com with questions.


MACRA Frequently Asked Questions

Why is the NAIC Medigap Model being revised?
A new federal law was passed on April 16, 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes changes to Medigap policies that cover the Part B deductibles for “newly eligible” Medicare Beneficiaries on or after January 1, 2020.

What does MACRA require?
As of January 1, 2020, MACRA does the following:
a. Prohibits first dollar Part B coverage on Medicare Supplement plans (Plans C and F) to “newly eligible” Medicare Beneficiaries; so Plans C and F cannot be sold to those “newly eligible” for Medicare. Those enrolled in Plans C and F prior to January 1, 2020 may keep their plan.
b. Makes Plans D and G the guarantee issue plans for “newly eligible” Medicare Beneficiaries for the specified periods under current law that name C or F for current Medicare beneficiaries.

Do the MACRA changes impact waivered states?
Three states (MA, MN and WI) obtained waivers from implementing the standardized Medicare Supplement plans because these states already had statewide standardized plans prior to 1990. Yes, these waivered states must comply with eliminating coverage for the Part B deductible.

Why are plans “redesignated” for only “newly eligible” Medicare beneficiaries?
The Federal Government wanted to eliminate coverage for the Part B deductible making consumers responsible for that first dollar coverage. The only difference between Plans C and F and Plans D and G is the coverage of the Part B deductible under Plans C and F. All other benefits are the same for D and G.
Since Plans C and F will no longer be available for “newly eligible” beneficiaries, it was necessary to designate Plans C and F as Plans D and G for these individuals.

What changes are made to High Deductible Plan options?
Since Plan F High Deductible cannot be sold to those “newly eligible” Medicare beneficiaries, a new Plan G High Deductible is created for those “newly eligible” Medicare beneficiaries as of January 1, 2020.

The effective date of coverage for Plan G High Deductible must be on or after January, 1 2020. If you are not a “newly eligible” beneficiary and are enrolled in a Plan F High Deductible prior to January 1, 2020, you are able to continue this coverage beyond January 1, 2020 and to purchase this coverage on or after January 1, 2020.

When can the new High Deductible Plan G be sold and who can buy it?
Plan G High Deductible can be made available beginning on January 1, 2020; “newly eligible” Medicare beneficiaries and current beneficiaries would be able to buy the new Plan G High Deductible.

What changes are made to Guaranteed Issue requirements?
Since two of the current guaranteed issue plans, Plans C and F, will no longer be available for “newly eligible” Medicare Beneficiaries on or after January 1, 2020, Plans D and G will become two of the guaranteed issue plans for these individuals.

Current enrollees can remain with or buy Plans C and F and individuals who do not fall within the definition of “newly eligible” will still be able to purchase Plans C and F.