Some members of the Senior Issues Task Force would like to have Medicare supplement plan cost-sharing model revisions ready for final approval by the end of the year.
The task force, an arm of the Health Insurance and Managed Care Committee at the National Association of Insurance Commissioners (NAIC), Kansas City, Mo., included a model revisions time line in the packet for its session at the NAIC’s summer meeting in Atlanta.
If the NAIC ends up adopting the model revisions, and if states build the changes into their own laws and regulations, consumers who have two types of popular no-deductible Medicare supplement plans, or “Medigap” plans — Medigap Plan C and Medigap Plan F — could face new co-payment requirements or other costs when they use Medicare to pay for scooters or for advanced imaging services, such as MRIs.
The traditional Medicare Part A hospitalization plan and the Medicare Part B physician services plan leave many gaps in coverage, in part to save money directly and in part to use out-of-pocket costs to discourage enrollees from getting unnecessary care.
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Many enrollees who have traditional Medicare coverage fill in the gaps by buying Medigap coverage. The federal government has created standardized plan types, and two of the plan types — Plan C and Plan F — pay all of an enrollee’s Medicare Plan A and Medicare Plan B deductibles.
The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for the NAIC and state insurance regulators to help control Medicare costs by working to change the Medigap Plan C and Medigap Plan F deductible rules, to reduce enrollees’ use of health care products and services. Congressional budget cutters have also asked for state regulators to help change Medigap cost-sharing rules.
The Senior Issues Task Force has set up a Medigap PPACA Subgroup to come up with a proposal for revising the provisions in the NAIC’s Medigap models that apply to Medigap Plan C and Medigap Plan F.