Medigap Changes in 2020

Emily WhicheloeMedicare AnswersLeave a Comment

As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), individuals who are newly eligible for Medicare on or after January 1, 2020 will not be able to purchase Medigap Plan C or Plan F (including the Plan F high deductible option). This is because after January 1, 2020, MACRA prevents individuals new to Medicare from purchasing Medigaps that pay for the Part B deductible ($185 in 2019). Both Plan C and Plan F cover the Part B deductible.

This law also applies to the three states (Massachusetts, Minnesota, and Wisconsin) that operate their own Medigap systems. People new to Medicare in those states will not be allowed to purchase Medigaps that pay for the Part B deductible.

Eligible for Medicare before January 1, 2020

These Medigap changes only affect individuals who are newly eligible for Medicare in 2020 and after.

If you are eligible for Medicare before January 1, 2020, you will still be able to purchase Plan C or Plan F. If you were eligible for Medicare before this time but did not enroll, you will be able to purchase Plan C or Plan F as long as you are within your Medigap open enrollment period or have a guaranteed issue right once you enroll in Original Medicare. (Remember that only those with Original Medicare can purchase a Medigap. Medigaps do not work with Medicare Advantage.) Visit Medicare Interactive to learn about protected times to buy a Medigap.

If you currently have Medigap Plan C or Plan F, you can continue to renew it from insurers in your state. As always, premiums for Medigaps can change from year to year, and Medigap issuers may choose to discontinue plan offerings. Your right to switch plans if your premiums increase depends on your state’s laws. If your Medigap is terminated, you will have a guaranteed issue period.

Eligible for Medicare on or after January 1, 2020

If you are newly eligible for Medicare on or after January 1, 2020, you will not be able to purchase Plan C or Plan F. However, Plan D and Plan G currently provide coverage for all the same out-of-pocket costs, except for the Part B deductible coverage.

Have Questions?

Contact your State Health Insurance Assistance Program (SHIP) to learn about Medigap enrollment and policy options in your state. Contact the Medicare Rights Center helpline at 800-333-4114 for general Medigap questions or for information about Medigaps in New York State.

Example: Individual can purchase Plan C or Plan F

Ricky will become eligible for Medicare in 2019. His 65th birthday is in November. He will continue to work and receive coverage from an employer with more than 20 employees, so he wants to delay Medicare enrollment until he retires in June 2020. Ricky can still purchase a Plan C or Plan F because he became eligible for Medicare before January 1, 2020, even though he did not enroll in Medicare or purchase his Medigap until after that date.

Example: Individual cannot purchase Plan C or Plan F

Martha will turn 65 on April 5, 2020, has not received Social Security Disability Insurance (SSDI), and does not have End-Stage Renal Disease (ESRD). She cannot purchase a Plan C or Plan F because she is newly eligible for Medicare after January 1, 2020. Instead, she can purchase Plan D or Plan G for coverage of almost all of the same out-of-pocket costs.

Example: Individuals eligible for Medicare due to disability

Note that under federal law, individuals only have the right to buy a Medigap if they are 65 or older. However, some states require companies to sell Medigap policies without medical underwriting (refusing to sell a policy, or charging more, because of a person’s health condition) to Medicare beneficiaries under 65. This includes people eligible because they receive SSDI or have ESRD.

Erik and his friend Wynn live in a state that provides Medigap enrollment rights for all individuals eligible for Medicare. Erik receives SSDI for 24 months and becomes eligible for Medicare in the 25th month, on October 1, 2019. He can buy a Plan C or Plan F. Wynn also receives SSDI, but his 25th month of SSDI is May 2020. He will not be able to purchase a Plan C or Plan F.

Erik will also be able to buy a Plan C or Plan F later, including when he turns 65 in 2022 and has his federal Medigap open enrollment period. Wynn will not be able to buy a Plan C or Plan F once he is 65, as he was newly eligible for Medicare after January 2020.

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