The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) took effect January 1, 2020. Below are answers to frequently asked questions.
What does MACRA require?
Prohibits first dollar Part B coverage on Medicare Supplement plans (Plans C and F) to “newly eligible” Medicare Beneficiaries; so Plans C and F cannot be sold to those “newly eligible” for Medicare. Those enrolled in Plans C and F prior to January 1, 2020 may keep their plan. Those individuals who became eligible for Medicare prior to January 1, 2020 may keep or purchase Plans C and F after December 31, 2019.
Makes Plans D and G the guarantee issue plans for “newly eligible” Medicare Beneficiaries for the specified periods under current law that name C or F for current Medicare beneficiaries.
Who is considered a “newly eligible” Medicare beneficiary under MACRA?
MACRA defines “newly eligible” as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020.
Do the MACRA changes impact waivered states?
Three states (MA, MN and WI) obtained waivers from implementing the standardized Medicare Supplement plans because these states already had statewide standardized plans prior to 1990. Yes, these waivered states must comply with eliminating coverage for the Part B deductible.
How are enrollees in current Plans C and F affected by these changes?
Current enrollees (those eligible for Medicare PRIOR to January 1, 2020) are not affected. Current enrollees can continue with their Plan C or Plan F, including F High Deductible plan, and may continue to buy Plans C or F beyond January 1, 2020. 6 MACRA did not change federal law regarding the offer of Plans C or F for individuals who are Medicare eligible before January 1, 2020.
What changes are made to High Deductible Plan options?
Since Plan F High Deductible cannot be sold to those “newly eligible” Medicare beneficiaries, a new Plan G High Deductible is created for those “newly eligible” Medicare beneficiaries as of January 1, 2020. The effective date of coverage for Plan G High Deductible must be on or after January, 1 2020. A beneficiary not “newly eligible” and enrolled in a Plan F High Deductible prior to January 1, 2020 is able to continue this coverage beyond January 1, 2020 and to purchase this coverage on or after January 1, 2020.
CMS provided the following question and response:
Question: I turn 65 in November 2019 and am eligible for Medicare. If I’m still working and covered by my employer-group employee medical plan, there might not be any reason for me to enroll in Part B during my birthday month. If I elect not to enroll, and end up enrolling when I retire sometime after January 1, 2020, would I be viewed as a “newly eligible” Medicare beneficiary and as a result would not be able to by C or F? Answer: You are NOT considered “newly eligible” because you turned age 65 before January 1, 2020; and although you must enroll in Part B to purchase Medigap and that would occur after January 1, 2020, you could purchase C or F because you turned age 65 before January 1, 2020.
Answer: You are NOT considered “newly eligible” because you turned age 65 before January 1, 2020; and although you must enroll in Part B to purchase Medigap and that would occur after January 1, 2020, you could purchase C or F because you turned age 65 before January 1, 2020.
Click here to view 2020 Medicare Handbook
Click here to view Medicare Supplement Plan Benefit Chart