Medicare Plans

2010 Changes to Medigap

The federal Medicare Improvements for Patients and Providers Act of 2008 (P.L. 110-275) required states to adopt certain changes to Medicare Supplement insurance policies. Under the new law, all of the Medigap Plans have been revised; some of the lettered plans were changed, some were dropped and some new ones were added.

Note: Minnesota, Massachusetts and Wisconsin have unique, state specific standardized plans. Minnesota and Wisconsin plan benefits changed due to MIPPA.

The following changes were made to Medigap and became effective June 1, 2010:

• Two new Medigap Plans were added, Plans M and N, with new cost sharing rules.
• Hospice benefit was added to the basic benefits of Plans A through D and Plans F and G (Plan E will no longer be available).
• Benefits for excess charges in Plan G were increased to 100%.
• Medigap Plans E, H, I, and J, including high-deductible Plan J, were dropped.
• Preventive Care benefits were dropped from all Plans because Medicare now covers many of these benefits.
• Home Recovery benefit was dropped from all Plans due to underuse.

Click Here to see a chart of the Medigap Plans available beginning June 1, 2010.

Q: What other changes did the new law make to Medigap?

A: The following changes were made to Medigap rules that require companies to issue a Medigap policy without health screening and without a new waiting period limitation:

• Guaranteed issue coverage now includes the right to buy a Medigap policy without health screenings or a new waiting period when an employer stops providing insurance that covers all of the cost for Medicare's 20% co-insurance.
• Open enrollment rights have been extended to include COBRA when this extension of employer coverage is lost, or when a person is only eligible for "Medicaid with a share of cost" because of an increase in their income or assets.
• When a person is entitled to "guaranteed issue" coverage or is applying under "open enrollment" rights, insurance companies cannot request, require or obtain medical information as part of the application process. The one exception to this rule occurs when a person is first enrolled in Medicare Part B; an insurance company can require answers to health questions as part of the application for a Medigap policy.

Q: What is the "Birthday Rule" and how does it apply to the new Medigap Plans?

A: In some states including California, if a person already has Medigap insurance they have 30 days of "open enrollment" following their birthday each year when they may buy a new Medigap policy without a medical screening or a new waiting period. The new policy must have the same or lesser benefits as the old policy. To avoid confusion, the new law specifies which of the new Plans are equal to the old Plans.

Q: Does an existing Medigap policyholder need to buy one of the new Medigap Plans?

A: No. If the person is satisfied with their current Medigap Plan, he/she can keep it as long as the premiums are paid. Agents should only recommend the purchase of a new Medigap Plan if the old Plan no longer meets the insureds needs or the premium is too high and he/she can buy a new Plan that meets his/her needs with a lower premium.

Q: What happens to the Medigap Plans people already have or buy before June 1, 2010?

A: Nothing happens to them. A Medigap Plan is guaranteed renewable for as long as the person wants to keep it and the premiums are paid. As long as the current Medigap policy is kept, the benefits will stay the same regardless of the changes to the law.

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• When Do I Sign Up for Medicare Parts A & B?
• How Much are Medicare Premiums, Deductibles and Coinsurance Rates?
• Can I Choose Medicare Advantage (Part C) Instead of Medicare Parts A & B?
• Medicare Advantage Plan Types and Enrollment Periods
• Are There Other Kinds of Medicare Health Plans?
• What Are My Options for Medicare Prescription Drug Coverage (Part D)?
• What Are Medigap (Medicare Supplement Insurance) Policies?
• Changes Made to Medigap Plans on June 1st, 2010
• Changes Made to Medigap Plans on January 1st, 2020