HCR Explained: The New Health Care Law and Medigap - AARP Bulletin

The New Health Care Law and Medigap

Your questions answered

Colin Anderson/Getty Images Q: I have a medigap policy. Will it change under the health care reform law? A: No. Medigap plans — also called Medicare supplemental plans — are a special kind of health insurance regulated by other federal and state laws. The new law currently does not change most medigap policies, though there may be changes later on, says Bonnie Burns, policy and training specialist at California Health Advocates, a consumer health advocacy group. These plans have a very specific purpose: to fill in the payment gaps in traditional Medicare coverage. They only kick in when you are responsible for a share of the bill, including copayments and deductibles but excluding monthly premiums. There are several health care reform rules that don't apply to medigap plans. Because Medicare doesn't cover beneficiaries' children, medigap plans don't have to follow the new law's requirement that private insurance plans cover young adult children under their parents' insurance. The law also requires most private or employer insurance plans to remove limits on how much they will pay for annually and over a member's lifetime. Medigap plans have no annual or lifetime limits on the amount they pay, says Burns, who serves on a medigap committee of the National Association of Insurance Commissioners. They have only a set limit on what portion of the beneficiary's bill they cover, not how much they will spend in any time period. The new law also prohibits insurers from discriminating against people when they get sick or if they have a preexisting health condition. Insurers selling medigap coverage already have strict rules requiring them to accept anyone who applies at these times: if you involuntarily lost your health insurance. if you apply during the open enrollment period. if you apply within six months of enrolling in Medicare Part B and you are 65 years old or older.

At other times, the insurer can decline to cover medical care for a preexisting health condition but only for up to six months. If you have questions about your individual situation, contact your
People under age 65 in Medicare have no guaranteed right to buy medigap coverage unless the state where they live requires insurers to do so. Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered. Cancel You are leaving AARP.org and going to the website of our trusted provider. The provider’s terms, conditions and policies apply. Please return to AARP.org to learn more about other benefits. Your email address is now confirmed. You'll start receiving the latest news, benefits, events, and programs related to AARP's mission to empower people to choose how they live as they age. You can also by updating your account at anytime. You will be asked to register or log in. Cancel Offer Details Disclosures

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