How MACRA Will Affect Your Medicare Coverage

There a lot of rumors circulating about MACRA this year. Some are true, some are not. MACRA is an acronym for The Medicare Access and CHIP Reauthorization Act of 2015. We will address some of the frequently asked questions about MACRA and how it affects Medigap coverage.



What is MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law in 2015. The law affects Medigap plans. It goes into effect on January 1, 2020

What Does MACRA Do?

There are two major changes that are coming under the new law:

  1. It eliminates so-called “First dollar” coverage. Medigap plans that pay for the Part B deductible cannot be sold to “newly eligible” Medicare beneficiaries. This will eliminate Plans C, F, and High Deductible F for these newly eligible individuals.
  2. It changes which plans are eligible for guarantee issue status. For specific scenarios where Guarantee Issue status may apply, see the website. The available GI plans starting in 2020 are Plan D, Plan G, and a new plan for 2020 – Plan High Deductible G.

Is Plan F Going Away?

No, it is not. If you have a Plan F, you can keep it after January 1, 2020. You can even apply to get a Plan F with a different company. The Plan F will not be available to those “newly eligible” to Medicare after that date. Even though you can keep it, there are several reasons to consider making a change away from Plan F. We recommend you change to a different Medigap lettered plan if you are able to.




What is a “Newly Eligible” Medicare Beneficiary?

Someone who is eligible for Medicare due to turning age 65 or who becomes eligible due to age, disability, or end-stage renal disease on or after January 1, 2020

How Does MACRA Affect Those Currently Enrolled in Plan C, F, or HDF?

Those currently enrolled in one of the discontinued plans will be able to keep their plan. They can also apply for a Plan C, F, or HDF with a different company after January 1, 2020. However, if applying with a new company, you will likely need to go through underwriting to make a change. They can also choose to apply for a Plan High Deductible G.

How Does MACRA Affect High Deductible Medicare Supplements?

You can continue your High Deductible Plan F coverage beyond January 1, 2020 if you so desire. However, there is a new Plan High Deductible G that will be available starting in 2020. Both “newly eligible” Medicare beneficiaries and current beneficiaries will be able to buy the new Plan High Deductible G.

What will happen to Guaranteed Issue requirements?

Plans D and G will become two of the guaranteed issue plans for “newly eligible” Medicare Beneficiaries on or after January 1, 2020. These will replace Plans C, F, and HDF for “newly eligible” beneficiaries going forward.

Because of Plan G taking on the bulk of the Guaranteed Issue enrollees from now on, we expect to see larger rate increases for those on Plan G going forward. This was the case with Plan F for many years. It is one of the main reasons we recommended Plan G over Plan F. There was a large difference in premium for very little difference in coverage between those because of Plan F taking on more people with pre-existing conditions. That will shift to Plan G starting in 2020. Therefore, our recommended going forward is Plan N.

Current enrollees can remain with Plans C, F and High Deductible F. Medicare beneficiaries who are not defined as “newly eligible” will still be able to purchase Plans C, F and High Deductible F from a different company pending underwriting requirements..

For more detailed information, you can review the NAIC implementation guidelines for MACRA.

To see if moving from Plan F is right for you and how the rates for any plans compare in your area, call us at 1-888-228-6119 or use the form to send us a question.

Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has over 22 years of experience working with Seniors to meet their insurance and financial needs.

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