Current through Register Vol. 50, No. 9, September 20, 2024
A. The Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA) requires the following
standards are applicable to all Medicare supplement policies or certificates
delivered or issued for delivery in this state to individuals newly eligible
for Medicare on or after January 1, 2020. No policy or certificate that
provides coverage of the Medicare Part B deductible may be advertised,
solicited, delivered or issued for delivery in this state as a Medicare
supplement policy or certificate to individuals newly eligible for Medicare on
or after January 1, 2020. All policies must comply with the following benefit
standards. Benefit plan standards applicable to Medicare supplement policies
and certificates issued to individuals eligible for Medicare before January 1,
2020, remain subject to the requirements of Regulation 33.
1. Benefit Requirements. The standards and
requirements of
§521 shall apply to all Medicare
supplement policies or certificates delivered or issued for delivery to
individuals newly eligible for Medicare on or after January 1, 2020, with the
following exceptions:
a. standardized
Medicare supplement benefit Plan C is redesignated as Plan D and shall provide
the benefits contained in
§521.A.5.c of this
regulation but shall not provide coverage for 100 percent or any portion of the
Medicare Part B deductible.
b.
standardized Medicare supplement benefit Plan F is redesignated as Plan G and
shall provide the benefits contained in
§521.A.5.e of this
regulation but shall not provide coverage for 100 percent or any portion of the
Medicare Part B deductible.
c.
standardized Medicare supplement benefit plans C, F, and F with high deductible
may not be offered to individuals newly eligible for Medicare on or after
January 1, 2020.
d. standardized
Medicare supplement benefit Plan F with high deductible is redesignated as Plan
G with high deductible and shall provide the benefits contained in
§521.A.5.f of this
regulation but shall not provide coverage for 100 percent or any portion of the
Medicare Part B deductible; provided further that, the Medicare Part B
deductible paid by the beneficiary shall be considered an out-of-pocket expense
in meeting the annual high deductible.
e. the reference to Plans C or F contained in
§521.A.1.b is deemed a
reference to Plans D or G for purposes of this section.
2. Applicability to Certain Individuals. This
§522, applies to only individuals that are newly eligible for Medicare on or
after January 1, 2020:
a. by reason of
attaining age 65 on or after January 1, 2020; or
b. by reason of entitlement to benefits under
part A pursuant to section 226(b) or 226A of the Social Security Act, or who is
deemed to be eligible for benefits under section 226(a) of the Social Security
Act on or after January 1, 2020.
3. Guaranteed Issue for Eligible Persons. For
purposes of
§535.E, in the case of
any individual newly eligible for Medicare on or after January 1, 2020, any
reference to a Medicare supplement policy C or F (including F with high
deductible) shall be deemed to be a reference to Medicare supplement policy D
or G (including G with high deductible), respectively, that meet the
requirements of this
§522 A.1.
4. Applicability to Waivered States. In the
case of a State described in section 1882(p)(6) of the Social Security Act
("waivered" alternative simplification states) MACRA prohibits the coverage of
the Medicare Part B deductible for any Medicare supplement policy sold or
issued to an individual that is newly eligible for Medicare on or after January
1, 2020.
5. Offer of Redesignated
Plans to Individuals other than Newly Eligible. On or after January 1, 2020,
the standardized benefit plans described in Subparagraph A.1.d, above may be
offered to any individual who was eligible for Medicare prior to January 1,
2020, in addition to the standardized plans described in
§521.A.5 of this
regulation.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
22:1111 (re-designated from LSA-R.S. 22:224 pursuant
to Acts 2008, No. 415 and
42 U.S.C.
1395 et seq.
