Medigap enrollment and consumer protections vary across states
- Collection:
- Health Policy and Services Research
- 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