Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 275 - Medicare Supplement Insurance
Section 031-275-9.2 - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020
Current through 2024-13, March 27, 2024
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the following standards to apply 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 Section 9.1.
A. Benefit Requirements. The standards and requirements of Section 9.1 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:
Drafting Note: Subsection A(4), above, implements the High Deductible Plan G as a redesignation of the prior High Deductible Plan F because federal law "deems" any reference to Plan F to be a reference to Plan G for "newly eligible" Medicare beneficiaries. High Deductible Plan G is the same as High Deductible Plan F except that where the annual out-of-pocket expenses are met with Medicare Part A expenses only, any subsequent Medicare Part B deductible expense incurred by the beneficiary after the required annual out-of-pocket expenses is met may not be paid for by High Deductible Plan G. Federal law prohibits the sale or issuance of any Medicare supplement policy that provides coverage of the Part B deductible to a "newly eligible" Medicare beneficiary and was enacted for the purpose of increasing cost-sharing and reducing "first dollar coverage." High Deductible plans meet this purpose. A beneficiary buying such a plan has a reasonable expectation that the plan will begin providing coverage after the beneficiary has paid the stated dollar amount in full, so making the beneficiary satisfy two separate deductible requirements on a cumulative basis would be a misleading description of the terms of the plan.
B. Applicability to Certain Individuals. This Section 9.2 applies only to individuals who are newly eligible for Medicare on or after January 1, 2020:
C. Offer of Redesignated Plans to Individuals Other Than Newly Eligible. On or after January 1, 2020, the standardized benefit plans described in subparagraph A(4) 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 section 9.1(E) of this Rule.
Drafting Note: The standardized benefit plans described in subparagraphs A(1) and A(2) above in this Section are also included as benefit plans D and G in Section 9.1(E)(4) and (7).
